proposed tax year 2010 forms and schedulesbasic individual study iv form 5329, additional taxes on...

Proposed Tax Year 2010Forms and Schedules

Statistics of Income Programs

Multi-Year Operating Plan

iii

Form 1040, U.S. Individual Income Tax Return .................................................................................................7Form 1040A, U.S. Individual Income Tax Return ..............................................................................................9Form 1040EZ, Income Tax Return for Single and Joint Filers With No Dependents ......................................11

Schedule A (Form 1040), Itemized Deductions ...........................................................................................12Schedule B (Form 1040A or 1040), Interest and Ordinary Dividends ........................................................13Schedule C (Form 1040), Profit or Loss From Business .............................................................................14Schedule C-EZ (Form 1040), Net Profit From Business .............................................................................16Schedule D (Form 1040), Capital Gains and Losses ....................................................................................17Schedule E (Form 1040), Supplemental Income and Loss ..........................................................................19Schedule EIC (Form 1040A or 1040), Earned Income Credit ....................................................................21Schedule F (Form 1040), Profit or Loss From Farming ...............................................................................22Schedule H (Form 1040), Household Employment Taxes ...........................................................................24Schedule J (Form 1040), Income Averaging for Farmers and Fishermen ...................................................26Schedule L (Form 1040A or 1040), Standard Deduction for Certain Filers ................................................28Schedule M (Form 1040A or 1040), Making Work Pay Credit ...................................................................29Schedule R (Form 1040A or 1040), Credit for the Elderly or the Disabled ................................................30Schedule SE (Form 1040), Self-Employment Tax .......................................................................................32

Form 982, Reduction of Tax Attributes Due to Discharge of Indebtedness .....................................................34Form 1116, Foreign Tax Credit .........................................................................................................................35Form 2106, Employee Business Expenses .......................................................................................................37Form 2106-EZ, Unreimbursed Employee Business Expenses .........................................................................39Form 2439, Notice to Shareholder of Undistributed Long-Term Capital Gains...............................................40Form 2441, Child and Dependent Care Expenses ............................................................................................41Form 2555, Foreign Earned Income .................................................................................................................43Form 2555-EZ, Foreign Earned Income Exclusion ..........................................................................................46Form 3468, Investment Credit ..........................................................................................................................48Form 3800, General Business Credit ................................................................................................................51Form 3903, Moving Expenses ..........................................................................................................................54Form 4136, Credit for Federal Tax Paid on Fuels .............................................................................................55Form 4137, Social Security and Medicare Tax on Unreported Tip Income .....................................................59Form 4562, Depreciation and Amortization .....................................................................................................60Form 4684, Casualties and Thefts .....................................................................................................................62Form 4797, Sales of Business Property ............................................................................................................64Form 4835, Farm Rental Income and Expenses ...............................................................................................66Form 4952, Investment Interest Expense Deduction ........................................................................................67Form 4972, Tax on Lump-Sum Distributions ...................................................................................................68

Proposed Tax Year 2010 Forms and SchedulesTable of Contents

Page

Preface ................................................................................................................................................................ xi

Individual Statistics Branch

Changes to Individual Statistics Branch Programs ..............................................................................................1

Basic Individual Study

iv

Form 5329, Additional Taxes on Qualified Plans (Including IRAs) and Other Tax-Favored Accounts ...........69Form 5405, First-Time Homebuyer Credit and Repayment of the Credit ........................................................71Form 5695, Residential Energy Credits ............................................................................................................73Form 5884, Work Opportunity Credit ...............................................................................................................75Form 5884-B, New Hire Retention Credit ........................................................................................................76Form 6198, At-Risk-Limitations .......................................................................................................................77Form 6251, Alternative Minimum Tax—Individuals .......................................................................................78Form 6252, Installment Sale Income ................................................................................................................80Form 6781, Gains And Losses From Section 1256 Contracts and Straddles ...................................................81Form 8283, Noncash Charitable Contributions ................................................................................................82Form 8396, Mortgage Interest Credit ...............................................................................................................84Form 8582, Passive Activity Loss Limitations .................................................................................................85Form 8586, Low-Income Housing Credit .........................................................................................................86Form 8606, Nondeductible IRAs ......................................................................................................................87Form 8609-A, Annual Statement for Low-Income Housing Credit .................................................................89Form 8615, Tax for Certain Children Who Have Investment Income of More Than $1,900 ...........................90Form 8801, Credit for Prior Year Minimum Tax—Individuals, Estates, and Trusts ........................................91Form 8812, Additional Child Tax Credit ..........................................................................................................95Form 8814, Parents’ Election To Report Child’s Interest and Dividends .........................................................96Form 8824, Like-Kind Exchanges ....................................................................................................................97Form 8829, Expenses for Business Use of Your Home ...................................................................................99Form 8834, Qualified Plug-in Electric and Electric Vehicle Credit ................................................................100Form 8835, Renewable Electricity, Refined Coal, and Indian Coal Production Credit ..................................102Form 8839, Qualified Adoption Expenses ......................................................................................................104Form 8844, Empowerment Zone and Renewal Community Employment Credit ..........................................106Form 8846, Credit for Employer Social Security and Medicare Taxes Paid on Certain Employee Tips .......107Form 8853, Archer MSAs and Long-Term Care Insurance Contracts............................................................108Form 8863, Education credits (American Opportunity and Lifetime Learning Credits) ................................110Form 8864, Biodiesel and Renewable Diesel Fuels Credit ............................................................................112Form 8874, New Markets Credit ....................................................................................................................113Form 8880, Credit for Qualified Retirement Savings Contributions ..............................................................114Form 8885, Health Coverage Tax Credit ........................................................................................................115Form 8888, Allocation of Refund (Including Savings Bond Purchases) ........................................................116Form 8889, Health Savings Accounts (HSAs) ................................................................................................117Form 8903, Domestic Production Activities Deduction ................................................................................119Form 8910, Alternative Motor Vehicle Credit ................................................................................................120Form 8911, Alternative Fuel Vehicle Refueling Property Credit ....................................................................121Form 8917, Tuition and Fees Deduction .........................................................................................................122Form 8919, Uncollected Social Security and Medicare Tax on Wages ..........................................................123Form 8936, Qualified Plug-in Electric Drive Motor Vehicle Credit ...............................................................124Form 8941, Credit for Small Employer Health Insurance Premiums .............................................................125Form W-2, Wage and Tax Statement ..............................................................................................................126

Basic Individual Study—continued

v

Schedule D, Capital Gains and Losses ........................................................................................................127Form 2439, Notice to Shareholder of Undistributed Long-Term Capital Gains.............................................129Form 4684, Casualties and Thefts ...................................................................................................................130Form 4797, Sales of Business Property ..........................................................................................................132Form 6252, Installment Sale Income ..............................................................................................................134Form 6781, Gains and Losses From Section 1256 Contracts and Straddles ..................................................135Form 8824, Like-Kind Exchanges ..................................................................................................................136

Sales of Capital Assets Study

Information Returns Match Study

Form W-2, Wage and Tax Statement .............................................................................................................138Form W-2G, Certain Gambling Winnings ......................................................................................................139Form 1098, Mortgage Interest Statement .......................................................................................................140Form 1098-C, Contributions of Motor Vehicles, Boats, and Airplanes ..........................................................141Form 1098-E, Student Loan Interest Statement ..............................................................................................142Form 1098-T, Tuition Statement .....................................................................................................................143Form 1099-B, Proceeds From Broker and Barter Exchange Transactions .....................................................144Form 1099-C, Cancellation of Debt ...............................................................................................................145Form 1099-CAP, Changes in Corporate Control and Capital Structure .........................................................146Form 1099-DIV, Dividends and Distributions ................................................................................................147Form 1099-G, Certain Government Payments ...............................................................................................148Form 1099-H, Health Coverage Tax Credit (HCTC) Advance Payments ......................................................149Form 1099-INT, Interest Income ....................................................................................................................150Form 1099-LTC, Long-Term Care and Accelerated Death Benefits ..............................................................151Form 1099-MISC, Miscellaneous Income .....................................................................................................152Form 1099-OID, Original Issue Discount ......................................................................................................153Form 1099-PATR, Taxable Distributions Received From Cooperatives .......................................................154Form 1099-Q, Payments From Qualified Education Programs (Under Sections 529 and 530) .....................155Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, etc .................................................................................................................................156Form 1099-S, Proceeds From Real Estate Transactions .................................................................................157Form 1099-SA, Distributions From an HSA, Archer MSA, or Medicare Advantage MSA ...........................158Form SSA-1099, Social Security Benefit Statement ......................................................................................159Form 5498, IRA Contribution Information .....................................................................................................160Form 5498-ESA, Coverdell ESA Contribution Information ..........................................................................161Form 5498-SA, HSA, Archer MSA, or Medicare Advantage MSA Information ...........................................162

Schedule K-1 (Form 1041), Beneficiary’s Share of Income, Deductions, Credits, etc ..............................163Schedule K-1 (Form 1065), Partner’s Share of Income, Deductions, Credits, etc ....................................164Schedule K-1 (Form 1120S), Shareholder’s Share of Income, Deductions, Credits, etc...........................165

vi

Form 706 (2009), United States Estate (and Generation-Skipping Transfer) Tax Return ..............................171Form 706-NA (2009), United States Estate (and Generation-Skipping Transfer) Tax Return, Estate of nonresident not a citizen of the United States .................................................................................188Form 709, United States Gift (and Generation-Skipping Transfer) Tax Return .............................................190

Special Studies Branch

Changes to Special Studies Branch Programs .................................................................................................167

Estate and Gift Programs

Tax-Exempt Organizations Programs

Form 990, Returns of Organization Exempt From Income Tax .....................................................................194Schedule A (Form 990 or 990-EZ), Public Charity Status and Public Support ........................................206Schedule B (Form 990, 990-EZ, or 990-PF), Schedule of Contributors...................................................210Schedule C (Form 990 or 990-EZ), Political Campaign and Lobbying Activities ...................................214Schedule D (Form 990), Supplemental Financial Statements ....................................................................218Schedule E (Form 990 or 990-EZ), Schools .............................................................................................223Schedule F (Form 990), Statement of Activities Outside the United States ..............................................225Schedule G (Form 990 or 990-EZ), Supplemental Information Regarding Fundraising or Gaming Activities ..................................................................................................................................230Schedule H (Form 990), Hospitals .............................................................................................................233Schedule I (Form 990), Grants and Other Assistance to Organizations, Governments, and Individuals in the United States ..........................................................................................................241Schedule J (Form 990), Compensation Information ..................................................................................243Schedule K (Form 990), Supplemental Information on Tax-Exempt Bonds .............................................246Schedule L (Form 990 or 990-EZ), Transactions With Interested Persons ...............................................248Schedule M (Form 990), Noncash Contributions ......................................................................................250Schedule N (Form 990 or 990-EZ), Liquidation, Termination, Dissolution, or Significant Disposition of Assets..................................................................................................................................252Schedule O (Form 990 or 990-EZ), Supplemental Information to Form 990 or 990-EZ .........................255Schedule R (Form 990), Related Organizations and Unrelated Partnerships ............................................257

Form 990-EZ, Short Form Return of Organization Exempt From Income Tax .............................................262Form 990-PF, Return of Private Foundation ..................................................................................................266

Schedule B (Form 990, 990-EZ, or 990-PF), Schedule of Contributors...................................................279Form 990-T, Exempt Organization Business Income Tax Return ..................................................................281Form 4720, Return of Certain Excise Taxes on Charities and Other Persons ................................................285Form 5227, Split-Interest Trust Information Return .......................................................................................294

vii

Form 8038, Information Return for Tax-Exempt Private Activity Bond Issues .............................................301Form 8038-B, Information Return for Build America Bonds and Recovery Zone Economic Development Bonds (under Internal Revenue Code section 149(e)) ............................................................303Form 8038-CP, Return for Credit Payments to Issuers of Qualified Bonds ...................................................305Form 8038-G, Information Return for Tax-Exempt Governmental Obligations ............................................306Form 8038-TC, Information Return for Tax Credit Bonds and Specified Tax Credit Bonds .........................308

Tax-Exempt Bonds Programs

International Special Studies

Form 1042-S, Foreign Person’s U.S. Source Income Subject to Withholding ...............................................313Form 1118, Foreign Tax Credit—Corporations ..............................................................................................316

Schedule I (Form 1118), Reduction of Foreign Oil and Gas Taxes ...........................................................321Schedule J (Form 1118), Adjustments to Separate Limitation Income (Loss) Categories for Determining Numerators of Limitation Fractions, Year-End Recharacterization Balances, and Overall Foreign and Domestic Loss Account Balances .....................................................323Schedule K (Form 1118), Foreign Tax Carryover Reconciliation Schedule ..............................................324

Form 1120-IC-DISC (2008), Interest Charge Domestic International Sales Corporation Return .................326Form 3520, Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts .................................................................................................................................332Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (Under section 6048(b)) .................................................................................................................................338Form 5471, Information Return of U.S. Persons With Respect to Certain Foreign Corporations .................342

Schedule J (Form 5471), Accumulated Earnings and Profits of Controlled Foreign Corporation ............346Schedule M (Form 5471), Transactions Between Controlled Foreign Corporation and Shareholders or Other Related Persons ...............................................................................................347

Form 5713, International Boycott Report .......................................................................................................348Schedule A (Form 5713), International Boycott Factor (Section 999(c)(1)) .............................................352Schedule B (Form 5713), Specifically Attributable Taxes and Income (Section 999(c)(2)) ......................354Schedule C (Form 5713), Tax Effect of the International Boycott Provisions ..........................................356

Form 8288-A, Statement of Withholding on Dispositions by Foreign Persons of U.S. Real Property Interests ......................................................................................................................358Form 8404 (2008), Interest Charge on DISC-Related Deferred Tax Liability ...............................................359Form 8805, Foreign Partner’s Information Statement of Section 1446 Withholding Tax ..............................361Form 8832, Entity Classification Election ......................................................................................................362Form 8858, Information Return of U.S. Persons With Respect to Foreign Disregarded Entities ..................364

Schedule M (Form 8858), Transactions Between Foreign Disregarded Entity of a Foreign Tax Owner and the Filer or Other Related Entities ....................................................................................366

viii

Form 1120, U.S. Corporation Income Tax Return ..........................................................................................372Schedule D (Form 1120), Capital Gains and Losses ..................................................................................377Schedule G (Form 1120), Information on Certain Persons Owning the Corporation’s Voting Stock .......378Schedule M-3 (Form 1120), Net Income (Loss) Reconciliation for Corporations With Total Assets of $10 Million or More .................................................................................................379Schedule N (Form 1120), Foreign Operations of U.S. Corporations .........................................................382Schedule O (Form 1120), Consent Plan and Apportionment Schedule for a Controlled Group ...............383Schedule UTP (Form 1120), Uncertain Tax Position Statement ................................................................387

Form 1120-F, U.S. Income Tax Return of a Foreign Corporation ..................................................................390Schedules M-1 and M-2 (Form 1120-F), Reconciliation of Income (Loss) and Analysis of Unappropriated Retained Earnings per Books ......................................................................................396Schedule M-3 (Form 1120-F), Net Income (Loss) Reconciliation for Foreign Corporations With Reportable Assets of $10 Million or More ........................................................................................397

Form 1120-L, U.S. Life Insurance Company Income Tax Return ..................................................................401Schedule M-3 (Form 1120-L), Net Income (Loss) Reconciliation for U.S. Life Insurance Companies With Total Assets of $10 Million or More .................................................................................................409

Form 1120-PC, U.S. Property and Casualty Insurance Company Income Tax Return ..................................412Schedule M-3 (Form 1120-PC), Net Income (Loss) Reconciliation for U.S. Property and Casualty Insurance Companies With Total Assets of $10 Million or More ........................................420

Form 1120-REIT, U.S. Income Tax Return for Real Estate Investment Trusts .............................................423Form 1120-RIC, U.S. Income Tax Return for Regulated Investment Companies .........................................427Form 1120S, U.S. Income Tax Return for an S Corporation ..........................................................................431

Schedule D (Form 1120S), Capital Gains and Losses and Built-In Gains .................................................435Schedule K-1 (Form 1120S), Shareholder’s Share of Income, Deductions, Credits, etc...........................436Schedule M-3 (Form 1120S), Net Income (Loss) Reconciliation for S Corporations With Total Assets of $10 Million or More .................................................................................................438

Form 1118, Foreign Tax Credit—Corporations ..............................................................................................441Form 3468, Investment Credit ........................................................................................................................444Form 3800, General Business Credit ..............................................................................................................447Form 4562, Depreciation and Amortization ...................................................................................................450Form 4626, Alternative Minimum Tax-Corporations .....................................................................................452Form 4797, Sales of Business Property ..........................................................................................................453Form 5472, Information Return of a 25% Foreign-Owned U.S. Corporation or a Foreign Corporation Engaged In a U.S. Trade of Business (Under Sections 6038A and 6038C of the Internal Revenue Code) .....................................................................................................455

Form 5884-B, New Hire Retention Credit ......................................................................................................457Form 5884, Work Opportunity Credit .............................................................................................................459

Corporation Statistics Branch

Changes to Corporation Statistics Branch Programs .......................................................................................367

Corporation Programs

ix

Form 6478, Credit for Alcohol Used as Fuel ..................................................................................................460Form 6765, Credit for Increasing Research Activities ....................................................................................461Form 8586, Low-Income Housing Credit .......................................................................................................463Form 8594, Asset Acquisition Statement ........................................................................................................464Form 8609-A, Annual Statement for Low-Income Housing Credit ...............................................................465Form 8611, Recapture of Low-Income Housing Credit .................................................................................466Form 8816, Special Loss Discount Account and Special Estimated Tax Payments for Insurance Companies ...............................................................................................................................467Form 8820, Orphan Drug Credit .....................................................................................................................468Form 8824, Like-Kind Exchanges ..................................................................................................................469Form 8825, Rental Real Estate Income and Expenses of a Partnership of an S Corporation .........................471Form 8826, Disabled Access Credit ................................................................................................................472Form 8827, Credit for Prior Year Minimum Tax—Corporations ...................................................................473Form 8834, Qualified Electric Vehicle Credit (Secondary Reference Only) ..................................................474Form 8835, Renewable Electricity, Refined Coal, and Indian Coal Production Credit ..................................476Form 8844, Empowerment Zone and Renewal Community Employment Credit ..........................................478Form 8845, Indian Employment Credit ..........................................................................................................479Form 8846, Credit for Employer Social Security and Medicare Taxes Paid on Certain Employee Tips ..............................................................................................................................480Form 8864, Biodiesel and Renewable Diesel Fuels Credit ............................................................................481Form 8869, Qualified Subchapter S Subsidiary Election (Under section 1361(b)(3) of the Internal Revenue Code .............................................................................482Form 8874, New Markets Credit ....................................................................................................................483Form 8881, Credit for Small Employer Pension Plan Startup Costs ..............................................................484Form 8882, Credit for Employer-Provided Childcare Facilities and Services ...............................................485Form 8896, Low Sulfur Diesel Fuel Production Credit ..................................................................................486Form 8903, Domestic Production Activities Deduction .................................................................................487Form 8910, Alternative Motor Vehicle Credit ................................................................................................488Form 8911, Alternative Fuel Vehicle Refueling Property Credit ....................................................................489Form 8916, Reconciliation of Schedule M-3 Taxable Income with Tax Return Taxable Income for Mixed Groups ................................................................................................................490Form 8916-A, Supplemental Attachment to Schedule M-3 ............................................................................491Form 8925, Report of Employer-Owned Life Insurance Contracts ................................................................493Form 8926, Disqualified Corporate Interest Expense Disallowed Under Section 163(j) and Related Information ................................................................................................................................494Form 8936, Qualified Plug-in Electric Drive Motor Vehicle Credit ...............................................................496Form 8941, Credit for Small Employer Health Insurance Premiums .............................................................497

Corporation Programs—continued

x

Form 1065, U.S. Return of Partnership Income .............................................................................................502Schedule D, Capital Gains and Losses ........................................................................................................507

Form 1065-B, U.S. Return of Partnership Income for Electing Large Partnerships ......................................508Schedule M-3, Net Income (Loss) Reconciliation for Certain Partnerships ...............................................513Schedule C, Additional Information for Schedule M-3 Filers ....................................................................516Schedule F (Form 1040), Profit or Loss from Farming ..............................................................................517

Form 3468, Investment Credit ........................................................................................................................518Form 3800, General Business Credit ..............................................................................................................521Form 4562, Depreciation and Amortization ...................................................................................................522Form 4797, Sales of Business Property ..........................................................................................................524Form 5884, Work Opportunity Credit .............................................................................................................525Form 5884-B, New Hire Retention Credit ......................................................................................................526Form 6765, Credit for Increasing Research Activities ....................................................................................527Form 8820, Orphan Drug Credit .....................................................................................................................529Form 8824, Like-Kind Exchanges ..................................................................................................................530Form 8825, Rental Real Estate Inc and Expenses of a Partnership or S Corp ................................................532Form 8834, Qualified Plug-in Electric and Electric Vehicle Credit ................................................................533Form 8844, Empowerment Zone and Renewal Community Employment Credit ..........................................534Form 8845, Indian Employment Credit ..........................................................................................................535Form 8846, Credit for Employer Social Security and Medicare Taxes Paid on Certain Employee Tips .......536Form 8864, Biodiesel and Renewable Diesel Fuels Credit ............................................................................537Form 8874, New Markets Credit ....................................................................................................................538Form 8881, Credit for Small Employer Pension Plan Startup Costs ..............................................................539Form 8882, Credit for Employer-Provided Child Care Facilities and Services .............................................540Form 8896, Low Sulfur Diesel Fuel Production Credit ..................................................................................541Form 8903, Domestic Production Activities Deduction .................................................................................542Form 8910, Alternative Motor Vehicle Credit ................................................................................................543Form 8911, Alternative Fuel Vehicle Refueling Property Credit ....................................................................544Form 8925, Report of Employer Owned Life Insurance Contracts ................................................................545Form 8936, Qualified Plug–in Electric Drive Motor Vehicle Credit ..............................................................546Form 8941, Credit for Small Employer Health Insurance Premiums .............................................................547Form 8752, Required Payment or Refund Under Section 7519 .....................................................................548

Partnership Programs

Changes to Corporation Statistics Branch Partnership Programs ....................................................................498

xi

Proposed Tax Year 2010 Forms and Schedules

Preface

This document contains the federal tax forms, schedules, and information documents that the Statistics of In-come (SOI) Division of the IRS has selected for its Tax Year (TY) 2010 program. This is the first time that SOI has made this document available to the general public. It is organized in 3 parts:

• Individual Statistics Branch studies include data related to the Form 1040 Individual income tax return series, as well as data on sales of capital assets and an extensive program that connects income tax returns with information documents filed by third parties.

• The Corporation Statistics Branch studies focus on data collected from the Form 1120 series and SOI’s Partnership program.

• Special Studies Branch programs include data collected for Estate and Gift Taxes, Tax-exempt Organiza-tions, and Tax-Exempt Bonds, as well as information collected for international filers.

Each tax form included in the SOI program is represented in this volume. Due to resource constraints, data from certain forms and schedules are collected periodically, rather than annually. For this reason, the contents of this document will vary somewhat from year to year. The information collected for each SOI project is developed in close collaboration with data users both inside and outside of the government. Most SOI programs are based on stratified samples of returns for which data are collected prior to IRS audits; therefore the data represent infor-mation as originally reported by taxpayers.

Returns for TY 2010 are filed primarily during calendar year 2011, although returns for fiscal-year filers or filers for whom filing extensions have been granted may not be received by the IRS until calendar year 2012. Conse-quently, data collected by SOI for TY 2010 will generally be made available to the public, in the form of tables and summary analyses, during calendar years 2012 and 2013.

The specific data items captured for each SOI project are indicated with a red block ( █ ) on facsimiles of the forms and schedules. Forms and schedules that can be filed by different types of taxpayers are repeated in sev-eral sections of this document. Specific changes to the data collected for each form and schedule since the TY 2009 studies are summarized at the beginning of each section. Draft copies of tax forms, or copies of tax forms from earlier tax years, were inserted in this document if TY2010 revisions of forms and schedules were not available at the time this document was produced.

1


Changes to Individual Statistics Branch Programs

Basic Individual Study

Forms 1040, 1040A, 1040EZ, U.S. Individual Income Tax Return series

Amounts listed as HSA on line 21 (other income) of the Form 1040 will be picked up.

The checkbox for Schedule L has been deleted. This line will still be picked up as part of processing.

Line 52 now only represents the credit amount from Form 5695; the credit amount from Form 8396 will now be picked up as part of the write-in credits for line 53c and the Form 8839 has been moved to the payments section of the 1040 (see below).

Line 70 now only represents the credit amount for federal tax on fuels from Form 4136. The credit amounts from Forms 2439 and 8885, as well as the refundable portion of Form 8801, will now picked up as part of line 71.

The adoption credit amount (Form 8839) is now refundable and will be picked up on line 71.

Schedule A, Itemized Deductions

The check box on line 29 has been deleted because the itemized deduction limitation has expired.

Schedule L, Standard Deduction for Certain Filers

Lines 7, 8, and 9 have been deleted. These lines were used to compute the state and local real estate tax deduction portion of the Schedule L deduction. The line 9 amount will continue to be picked up for prior year returns.

Schedule M, Making Work Pay and Government Retiree Credits

The check box on line 1a will be picked up this year.

Lines 11, 12, and 13 have been deleted. These lines were used to compute the Government Retiree Credit. The Government Retiree Credit has been deleted in 2010, and the Schedule M only applies to the Making Work Pay credit this year.

Form 982, Reduction of Tax Attributes Due to Discharge of Indebtedness

The check box for indebtedness due to the Midwestern Disaster Area has been deleted from the form.

Form 3468, Investment Credit

New for TY 2010, qualifying therapeutic discovery project credit (line 8) will be picked up.

2




Form 3800, General Business Credit

There are 2 new credits for TY 2010 that will be picked up. Line 1aa, New Hire Retention Credit, and line 29h, Credit for small employer health insurance premiums from Form 8941. The welfare-to-work credit (old line 1b) and credit for contributions to selected community development corporations (old line 1aa) have expired and been removed from the form.

Form 4684, Casualties and Thefts

Lines 17 and 18 have been combined to calculate casualty and theft from a disaster area; this amount is reported on Schedule A.

Form 5405, First-Time Homebuyer Credit and Repayment of the Credit

Line 16 added two check boxes, 16a to report the disposition or change in use of your main home, and 16b to make an installment payment of the 2008 credit.

Form 5695, Residential Energy Credits

Lines 7 and 8 in Part I are new and will be picked up. These lines are used to document the amount of nonbusiness energy property credit taken in 2009.

Line 29, the sum of the nonbusiness energy property credit and the residential energy efficient prop-erty credit, has been deleted. This amount will still be picked up as part of the processing of the form.

Form 5884-B, New Hire Retention Credit

This is a new form, lines 2 through 13 will be picked up.

Form 6251, Alternative Minimum Tax—Individuals

Line 6, the itemized deduction limitation, has been deleted from the form but will continue to be picked up for prior year returns.

Form 6252, Installment Sale Income

New for TY 2010, lines 30–34 will be picked up to help better calculate the amount carried to Sched-ule D or Form 4797.

Form 8396, Mortgage Interest Credit

Lines 8 through 10 have been replaced by a new line 8, which is the amount from the new Credit Limit Worksheet.

3




Form 8582, Passive Activity Loss Limitations

Line 2a (Commercial Revitalization Deductions) and 2c (Add Lines 2a and 2b) have been deleted from the form.

Form 8606, Nondeductible IRAs

Old lines 15a and 15b have been deleted from the form; line 15c is now line 15.

Part II added new lines 19, 20a, and 20b; these were added to allow taxpayer to claim all taxable amounts in 2010 or claim them in future years.

Added a new section, Part III; lines 21–25b, which reports rollovers from qualified retirement plans to Roth IRA’s.

Part IV has been revised to reflect possible reporting of taxable amounts in future years, and has added new lines 33–35.

Form 8801, Credit for Prior Year Minimum Tax—Individuals, Estates, and Trusts

Lines 22 and 23, which pertained to the 50 percent of total interest and penalties paid before October 13, 2008 on alternative minimum tax that was used in computing the nonrefundable credit in TY2009, has been removed. Subsequent lines have been renumbered accordingly.

Form 8829, Expenses for Business Use of Your Home

Up to three forms will now be picked up.

Form 8835, Renewable Electricity, Refined Coal, and Indian Coal Production Credit

Lines 13a–d and lines 14a–f are new and will be picked up. These new lines are used to document the type of facility used to produce electricity.

Form 8839, Qualified Adoption Expenses

Information for a 3rd child was added to Part I and II; we will pick up items b through g and line 5c for Child 3.

Form 8844, Empowerment Zone and Renewal Community Employment Credit

The Renewal Community Employment Credit has expired for calendar years after 2009. Therefore, line 1b will not be picked up for this year.

4




Form 8863, Education Credits (American Opportunity and Lifetime Learning Credits)

The Hope Credit has been removed for TY 2010; it will be picked up for prior year returns.

Form 8888, Allocation of Refund (Including Savings Bond Purchases)

Form 8888, “Direct Deposit of Refund to More Than One Account” was renamed “Allocation of Re-fund (Including Savings Bond Purchases)”.

Part I, Direct Deposit. We will pick up lines 1a, 2a, and 3a. Line 4 is now used for Bonds, (see Part II).

Part II, U.S. Series I Savings Bond Purchases is new. We will pick up lines 4, 5a, and 6a.

Part III, Paper Check is new. We will pick up line 7.

Part IV, Total Allocation of Refund is new. We will pick up line 8.

Form 8903, Domestic Production Activities Deduction

Oil-related Production Activities are now separated on the form and will be picked up for lines 1a through 7a and line 10a. Also, lines 14a, 14b, and 15, will be picked up as part of the program this year.

Form 8941, Credit for Small Employer Health Insurance Premiums

This is a new form, lines 1 through 19 and line 21 will be picked up.

Sales of Capital Assets (SOCA) Study

Form 4684, Casualties and Thefts

Lines 17 and 18 have been combined to calculate casualty and theft from a disaster area; this amount is reported on Schedule A.

Form 6252, Installment Sale Income

New for TY 2010, lines 30–34 will be picked up to help better calculate the amount carried to Sched-ule D or Form 4797.

5



Sales of Capital Assets (SOCA) Study—continued

Form 8824, Like-Kind Exchanges

Added lines 9, 10, 11a, 11b and 11c for SOCA edit. These lines are check boxes that provide informa-tion on related party exchanges.

Information Returns Match Study

Form W-2, Wage and Tax Statement

A new payment code, Code CC, titled “HIRE exempt wages and tips” was added.

Form 1099-INT, Interest Income

Two new payment codes were added: “Tax-exempt interest” (box 8) and “Specified private activity bond interest” (box 9). Box 10, “Tax-exempt bond CUSIP no.”, was also added.

7Basic Individual Study

Form 1040 Department of the Treasury—Internal Revenue Service

(99) IRS Use Only—Do not write or staple in this space. U.S. Individual Income Tax Return 2010Name, Address, and SSN

See separate instructions.

P R I N T

C L E A R L Y

For the year Jan. 1–Dec. 31, 2010, or other tax year beginning , 2010, ending , 20 OMB No. 1545-0074 Your first name and initial Last name Your social security number

If a joint return, spouse’s first name and initial Last name Spouse’s social security number

Home address (number and street). If you have a P.O. box, see instructions. Apt. no.

▲Make sure the SSN(s) above and on line 6c are correct.

City, town or post office, state, and ZIP code. If you have a foreign address, see instructions. Checking a box below will not change your tax or refund.

Presidential Election Campaign ▶ Check here if you, or your spouse if filing jointly, want $3 to go to this fund . . . . . ▶ You Spouse

Filing Status

Check only one box.

1 Single

2 Married filing jointly (even if only one had income)

3 Married filing separately. Enter spouse’s SSN above and full name here. ▶

4 Head of household (with qualifying person). (See instructions.) If

the qualifying person is a child but not your dependent, enter this

child’s name here. ▶

5 Qualifying widow(er) with dependent child

Exemptions

If more than four dependents, see instructions and check here ▶

6a Yourself. If someone can claim you as a dependent, do not check box 6a . . . . .

b Spouse . . . . . . . . . . . . . . . . . . . . . . . .} Boxes checked

on 6a and 6b

c Dependents:

(1) First name Last name

(2) Dependent’s social security number

(3) Dependent’s relationship to you

(4) ✓ if child under age 17 qualifying for child tax credit

(see page 15)

No. of children on 6c who: • lived with you • did not live with you due to divorce or separation (see instructions)

Dependents on 6c not entered above

d Total number of exemptions claimed . . . . . . . . . . . . . . . . .Add numbers on lines above ▶

Income

Attach Form(s) W-2 here. Also attach Forms W-2G and 1099-R if tax was withheld.

If you did not get a W-2, see page 20.

Enclose, but do not attach, any payment. Also, please use Form 1040-V.

7 Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . 7

8a Taxable interest. Attach Schedule B if required . . . . . . . . . . . . 8a

b Tax-exempt interest. Do not include on line 8a . . . 8b

9 a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . 9a

b Qualified dividends . . . . . . . . . . . 9b

10 Taxable refunds, credits, or offsets of state and local income taxes . . . . . . 10

11 Alimony received . . . . . . . . . . . . . . . . . . . . . 11

12 Business income or (loss). Attach Schedule C or C-EZ . . . . . . . . . . 12

13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ▶ 13

14 Other gains or (losses). Attach Form 4797 . . . . . . . . . . . . . . 14

15 a IRA distributions . 15a b Taxable amount . . . 15b

16 a Pensions and annuities 16a b Taxable amount . . . 16b

17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17

18 Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . 18

19 Unemployment compensation . . . . . . . . . . . . . . . . . 19

20 a Social security benefits 20a b Taxable amount . . . 20b

21 Other income. List type and amount 21 22 Combine the amounts in the far right column for lines 7 through 21. This is your total income ▶ 22

Adjusted Gross Income

23 Educator expenses . . . . . . . . . . 23

24 Certain business expenses of reservists, performing artists, and fee-basis government officials. Attach Form 2106 or 2106-EZ 24

25 Health savings account deduction. Attach Form 8889 . 25

26 Moving expenses. Attach Form 3903 . . . . . . 26

27 One-half of self-employment tax. Attach Schedule SE . 27

28 Self-employed SEP, SIMPLE, and qualified plans . . 28

29 Self-employed health insurance deduction . . . . 29

30 Penalty on early withdrawal of savings . . . . . . 30

31 a Alimony paid b Recipient’s SSN ▶ 31a

32 IRA deduction . . . . . . . . . . . . . 32

33 Student loan interest deduction . . . . . . . . 33

34 Tuition and fees. Attach Form 8917 . . . . . . . 34

35 Domestic production activities deduction. Attach Form 8903 35

36 Add lines 23 through 31a and 32 through 35 . . . . . . . . . . . . . 36 37 Subtract line 36 from line 22. This is your adjusted gross income . . . . . ▶ 37

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11320B Form 1040 (2010)

FILING PERIOD DLN

(zip code)

1st thru 10th 1st thru 4th

5th thru 10th

parents

other dep

1st thru 4th

5th thru 10th

dependent other earned inc

(13) cap gain distrib

NOLfrgn ernd inc excl

(21) stock options(21) gambling income

frgn housing dedother deductions

Archer MSA

(21) cancellation of debt

qual char/HSA dist

(21) Frm 8889 HSA inc (*)

8 Basic Individual Study

Form 1040 (2010) Page 2

Tax and Credits

38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . 38

39a Check if:

{ You were born before January 2, 1946, Blind.

Spouse was born before January 2, 1946, Blind.} Total boxes

checked ▶ 39a

b If your spouse itemizes on a separate return or you were a dual-status alien, check here ▶ 39b

40 Itemized deductions (from Schedule A) or your standard deduction (see inst uctions) . . 40

41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . . . 41

42 Exemptions. Multiply $3,650 by the number on line 6d . . . . . . . . . . . 42

43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- . . 43

44 Tax (see instructions). Check if any tax is from: a Form(s) 8814 b Form 4972 . 44

45 Alternative minimum tax (see instructions). Attach Form 6251 . . . . . . . . . 45

46 Add lines 44 and 45 . . . . . . . . . . . . . . . . . . . . . ▶ 46

47 Foreign tax credit. Attach Form 1116 if required . . . . 47

48 Credit for child and dependent care expenses. Attach Form 2441 48

49 Education credits from Form 8863, line 23 . . . . . 49

50 Retirement savings contributions credit. Attach Form 8880 50

51 Child tax credit (see instructions) . . . . . . . . 51

52 Residential energy credits. Attach Form 5695 . . . . 52

53 Other credits from Form: a 3800 b 8801 c 53

54 Add lines 47 through 53. These are your total credits . . . . . . . . . . . . 5455 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0- . . . . . . ▶ 55

Other Taxes

56 Self-employment tax. Attach Schedule SE . . . . . . . . . . . . . . . 56

57 Unreported social security and Medicare tax from Form: a 4137 b 8919 . . 57

58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required . . 58

59 a Form(s) W-2, box 9 b Schedule H c Form 5405, line 16 . . . . 59

60 Add lines 55 through 59. This is your total tax . . . . . . . . . . . ▶ 60

Payments 61 Federal income tax withheld from Forms W-2 and 1099 . . 61

62 2010 estimated tax payments and amount applied from 2009 return 62

63 Making work pay credit. Attach Schedule M . . . . . . . 63 If you have a qualifying child, attach Schedule EIC.

64a Earned income credit (EIC) . . . . . . . . . 64a

b Nontaxable combat pay election 64b

65 Additional child tax credit. Attach Form 8812 . . . . . . 65

66 American opportunity credit from Form 8863, line 14 . . . 66

67 First-time homebuyer credit from Form 5405, line 10 . . . 67

68 Amount paid with request for extension to file . . . . . 68

69 Excess social security and tier 1 RRTA tax withheld . . . . 69

70 Credit for federal tax on fuels. Attach Form 4136 . . . . 70

71 Credits from Form: a 2439 b 8839 c 8801 d 8885 71 72 Add lines 61, 62, 63, 64a, and 65 through 71. These are your total payments . . . . ▶ 72

73 If line 72 is more than line 60, subtract line 60 from line 72. This is the amount you overpaid 73Refund 74a Amount of line 73 you want refunded to you. If Form 8888 is attached, check here . ▶ 74a

Direct deposit? See instructions.

▶

▶

b Routing number ▶ c Type: Checking Savings

d Account number

75 Amount of line 73 you want applied to your 2011 estimated tax ▶ 75 Amount You Owe

76 Amount you owe. Subtract line 72 from line 60. For details on how to pay, see instructions ▶ ▶76

77 Estimated tax penalty (see instructions) . . . . . . . 77

Third Party Designee

Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete below. No

Designee’s name ▶

Phone no. ▶

Personal identification number (PIN) ▶

Sign Here Joint return? See page 12. Keep a copy for your records.

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Your signature Date Your occupation Daytime phone number

Spouse’s signature. If a joint return, both must sign.

▲

Date Spouse’s occupation

Paid Preparer Use Only

Print/Type preparer’s name Preparer’s signature Date Check if self-employed

PTIN

Firm’s name ▶ Firm's EIN ▶

Firm’s address ▶ Phone no.

Form 1040 (2010)

additional deditemized ded

dependent status

other credits

(54c)

recapture:Form 4255

other

refund anticipation loandirect deposit

PY earned inc

Alt mot vh cr

rl est tx/dis loss ded

Cr for elderlyElec veh crAlt ful vh crPlugin vh cr

COBRAForm 4970

Recvry reb cr

ccf reduction amt

Sch L ind

MIC cr

Other payments


Form

1040A 2010U.S. Individual Income Tax ReturnDepartment of the Treasury—Internal Revenue Service

OMB No. 1545-0074

IRS Use Only—Do not write or staple in this space. (99)

Name, Address, and SSN See separate instructions.

P R I N T

C L E A R L Y

Your first name and initial Last name

Your social security number


Home address (number and street). If you have a P.O. box, see instructions. Apt. no.▲ Make sure the SSN(s) above

and on line 6c are correct.

City, town or post office, state, and ZIP code. If you have a foreign address, see instructions. Checking a box below will not change your tax or refund.Presidential

Election Campaign ▶ Check here if you, or your spouse if filing jointly, want $3 to go to this fund . . . . . . ▶ You Spouse

Filing status Check only one box.

1 Single2 Married filing jointly (even if only one had income)3 Married filing separately. Enter spouse’s SSN above and

full name here. ▶

4 Head of household (with qualifying person). (See instructions.)If the qualifying person is a child but not your dependent, enter this child’s name here. ▶

5 Qualifying widow(er) with dependent child (see instructions)

6a Yourself. If someone can claim you as a dependent, do not check box 6a.

b Spousec Dependents:

(1) First name Last name

(2) Dependent’s social security number

(3) Dependent’s relationship to you

(4) ✓ if child under age 17 qualifying for child tax credit (see

page 16)If more than six dependents, see instructions.

} Boxes checked on 6a and 6bNo. of children on 6c who: • lived with you

• did not live with you due to divorce or separation (see instructions)

Dependents on 6c not entered above

d Total number of exemptions claimed.

Add numbers on lines above ▶

Income Attach Form(s) W-2 here. Also attach Form(s) 1099-R if tax was withheld. If you did not get a W-2, see page 20. Enclose, but do not attach, any payment. Also, please use Form 1040-V.

7 Wages, salaries, tips, etc. Attach Form(s) W-2. 7

8a Taxable interest. Attach Schedule B if required. 8ab Tax-exempt interest. Do not include on line 8a. 8b

9a Ordinary dividends. Attach Schedule B if required. 9ab Qualified dividends (see instructions). 9b

10 Capital gain distributions (see instructions). 1011a IRA

distributions. 11a11b Taxable amount

(see instructions). 11b12a Pensions and

annuities. 12a12b Taxable amount

(see instructions). 12b

13 Unemployment compensation and Alaska Permanent Fund dividends. 1314a Social security

benefits. 14a14b Taxable amount

(see instructions). 14b

15 Add lines 7 through 14b (far right column). This is your total income. ▶ 15Adjusted gross income

16 Educator expenses (see instructions). 1617 IRA deduction (see instructions). 1718 Student loan interest deduction (see instructions). 18

19 Tuition and fees. Attach Form 8917. 1920 Add lines 16 through 19. These are your total adjustments. 20

21 Subtract line 20 from line 15. This is your adjusted gross income. ▶ 21For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11327A Form 1040A (2010)

up to ten dependents parents 1st thru 4th

5th thru 10th other dependents

Filing Period DLN

(zip code)

1st thru 4th

5th thru 10th

other income

Penalty on early withdrawal

qual char dist

Exemptions


Form 1040A (2010) Page 2Tax, credits, and payments

22 Enter the amount from line 21 (adjusted gross income). 2223a Check

if: { You were born before January 2, 1946, BlindSpouse was born before January 2, 1946, Blind }Total boxes

checked ▶ 23ab If you are married filing separately and your spouse itemizes

deductions, see page 30 and check here ▶ 23b24 Enter your standard deduction (see instructions). 2425 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-. 2526 Exemptions. Multiply $3,650 by the number on line 6d. 2627 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-.

This is your taxable income. ▶ 2728 Tax, including any alternative minimum tax (see instructions). 2829 Credit for child and dependent care expenses. Attach Form 2441. 2930 Credit for the elderly or the disabled. Attach

Schedule R. 3031 Education credits from Form 8863, line 23. 3132 Retirement savings contributions credit. Attach Form 8880. 3233 Child tax credit (see instructions). 3334 Add lines 29 through 33. These are your total credits. 3435 Subtract line 34 from line 28. If line 34 is more than line 28, enter -0-. 3536 Advance earned income credit payments from Form(s) W-2, box 9. 3637 Add lines 35 and 36. This is your total tax. ▶ 3738 Federal income tax withheld from Forms W-2 and 1099. 3839 2010 estimated tax payments and amount applied

from 2009 return. 3940 Making work pay credit. Attach Schedule M. 40

If you have a qualifying child, attach Schedule EIC.

41a Earned income credit (EIC). 41ab Nontaxable combat pay election. 41b

42 Additional child tax credit. Attach Form 8812. 4243 American opportunity credit from Form 8863, line 14. 4344 Add lines 38, 39, 40, 41a, 42, and 43. These are your total payments. ▶ 44

Refund Direct deposit? See instructions and fill in 46b, 46c, and 46d or Form 8888.

45 If line 44 is more than line 37, subtract line 37 from line 44. This is the amount you overpaid. 45

46a Amount of line 45 you want refunded to you. If Form 8888 is attached, check here ▶ 46a

▶ b Routing number

▶ c Type: Checking Savings

▶ d Account number

47 Amount of line 45 you want applied to your 2011 estimated tax. 47

Amount you owe

48 Amount you owe. Subtract line 44 from line 37. For details on how to pay, see instructions. ▶ 48

49 Estimated tax penalty (see instructions). 49

Third party designee

Do you want to allow another person to discuss this return with the IRS (see instructions)? Yes. Complete the following. No


Phone no. ▶


Sign hereJoint return? See page 13.Keep a copy for your records.

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge.▲ Your signature Date Your occupation Daytime phone number

Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation

Paid preparer use only

Print/type preparer's name Preparer’s signature DateCheck ▶ if self-employed

PTIN

Firm's name ▶

Firm's address ▶

Firm's EIN ▶

Phone no.

Form 1040A (2010)

Adoption cr (PY)

additional deductionsdependent status

ALT MIN TAX

excess FICA w/held

Form 4868 payment

direct deposit

refund anticipation loan

PY earned increcv rebate cr

real est tx deduction

Other payments

Sch L ind


Form

1040EZ

Department of the Treasury—Internal Revenue Service

Income Tax Return for Single and Joint Filers With No Dependents (99) 2010 OMB No. 1545-0074

Name, Address, and SSN See separate instructions.

P R I N T

C L E A R L Y

Your first name and initial Last name Your social security number


Home address (number and street). If you have a P.O. box, see instructions. Apt. no. Make sure the SSN(s) above are correct.▲ ▲

City, town or post office, state, and ZIP code. If you have a foreign address, see instructions.Checking a box below will not change your tax or refund.Presidential

Election Campaign (see page 9)

▲

Check here if you, or your spouse if a joint return, want $3 to go to this fund . . ▶ You Spouse

IncomeAttach Form(s) W-2 here.

1 Wages, salaries, and tips. This should be shown in box 1 of your Form(s) W-2. Attach your Form(s) W-2. 1

2 Taxable interest. If the total is over $1,500, you cannot use Form 1040EZ. 2

Enclose, but do not attach, any payment.

3 Unemployment compensation and Alaska Permanent Fund dividends (see page 11). 3

4 Add lines 1, 2, and 3. This is your adjusted gross income. 4 You may be entitled to a larger deduction if you file Form 1040A or 1040. See Before You Begin on page 4.

5 If someone can claim you (or your spouse if a joint return) as a dependent, check the applicable box(es) below and enter the amount from the worksheet on back.

You SpouseIf no one can claim you (or your spouse if a joint return), enter $9,350 if single; $18,700 if married filing jointly. See back for explanation. 5

6 Subtract line 5 from line 4. If line 5 is larger than line 4, enter -0-. This is your taxable income. ▶ 6

Payments, Credits, and Tax

7 Federal income tax withheld from Form(s) W-2 and 1099. 7 8 Making work pay credit (see worksheet on back). 8 9 a Earned income credit (EIC) (see page 13). 9a

b Nontaxable combat pay election. 9b 10 Add lines 7, 8, and 9a. These are your total payments and credits. ▶ 10 11 Tax. Use the amount on line 6 above to find your tax in the tax table on pages 27

through 35 of the instructions. Then, enter the tax from the table on this ne. 11

Refund 12a If line 10 is larger than line 11, subtract line 11 from line 10. This is your refund. If Form 8888 is attached, check here ▶ 12a

Have it directly deposited! See page 18 and fill in 12b, 12c, and 12d or Form 8888.

▶ b Routing number ▶ c Type: Checking Savings

▶ d Account number

Amount You Owe

13 If line 11 is larger than line 10, subtract line 10 from line 11. This is the amount you owe. For details on how to pay, see page 19. ▶ 13

Third Party Designee

Do you want to allow another person to discuss this return with the IRS (see page 20)? Yes. Complete the following. No


Phone no. ▶


Sign Here

Under penalties of perjury, I declare that I have examined this return, and to the best of my knowledge and belief, it is true, correct, and accurately lists all amounts and sources of income I received during the tax year. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge.

Joint return? See page 6.

Keep a copy for your records.

▲

Your signature Date Your occupation Daytime phone number

Spouse’s signature. If a joint return, both must sign. Date Spouse’s occupation

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 36. Cat. No. 11329W Form 1040EZ (2010)


Print/Type preparer’s name Preparer’s signature DateCheck if self-employed

PTIN

Firm’s name ▶

Firm’s address ▶

Firm's EIN ▶

Phone no.

dependent status Total exemptions

Filing Period DLN

(zip code)

tax exempt interest

excess soc sec w/held

F4868 payment

direct deposit

refund anticipation loan

other income

PY earned incRecovery reb cr


SCHEDULE A (Form 1040)

Department of the Treasury Internal Revenue Service (99)

Itemized Deductions

▶ Attach to Form 1040. ▶ See Instructions for Schedule A (Form 1040).

OMB No. 1545-0074

2010Attachment Sequence No. 07

Name(s) shown on Form 1040 Your social security number

Medical and Dental Expenses

Caution. Do not include expenses reimbursed or paid by others. 1 Medical and dental expenses (see instructions) . . . . . 1 2 Enter amount from Form 1040, line 38 2 3 Multiply line 2 by 7.5% (.075) . . . . . . . . . . . 3 4 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0- . . . . . . . . 4

Taxes You Paid

5 State and local (check only one box): a Income taxes, orb General sales taxes } . . . . . . . . . . . 5

6 Real estate taxes (see instructions) . . . . . . . . . 6 7 New motor vehicle taxes from line 11 of the worksheet on

back (for certain vehicles purchased in 2009). Skip this line if you checked box 5b . . . . . . . . . . . . . . 7

8 Other taxes. List type and amount ▶

8 9 Add lines 5 through 8 . . . . . . . . . . . . . . . . . . . . . . 9

Interest You Paid Note. Your mortgage interest deduction may be limited (see instructions).

10 Home mortgage interest and points reported to you on Form 1098 10

11 Home mortgage interest not reported to you on Form 1098. If paid to the person from whom you bought the home, see instructions and show that person’s name, identifying no., and address ▶

11 12 Points not reported to you on Form 1098. See instructions for

special rules . . . . . . . . . . . . . . . . . 12 13 Mortgage insurance premiums (see instructions) . . . . . 13 14 Investment interest. Attach Form 4952 if required. (See instructions.) 14 15 Add lines 10 through 14 . . . . . . . . . . . . . . . . . . . . . 15

Gifts to Charity If you made a gift and got a benefit for it, see instructions.

16 Gifts by cash or check. If you made any gift of $250 or more, see instructions . . . . . . . . . . . . . . . . 16

17 Other than by cash or check. If any gift of $250 or more, see instructions. You must attach Form 8283 if over $500 . . 17

18 Carryover from prior year . . . . . . . . . . . 1819 Add lines 16 through 18 . . . . . . . . . . . . . . . . . . . . . 19

Casualty and Theft Losses 20 Casualty or theft loss(es). Attach Form 4684. (See instructions.) . . . . . . . . 20 Job Expenses and Certain Miscellaneous Deductions

21 Unreimbursed employee expenses—job travel, union dues, job education, etc. Attach Form 2106 or 2106-EZ if required. (See instructions.) ▶ 21

22 Tax preparation fees . . . . . . . . . . . . . 22 23 Other expenses—investment, safe deposit box, etc. List type

and amount ▶

23 24 Add lines 21 through 23 . . . . . . . . . . . . 24 25 Enter amount from Form 1040, line 38 25 26 Multiply line 25 by 2% (.02) . . . . . . . . . . . 26 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter -0- . . . . . . 27

Other Miscellaneous Deductions

28 Other—from list in instructions. List type and amount ▶

28 Total Itemized Deductions

29 Add the amounts in the far right column for lines 4 through 28. Also, enter this amount on Form 1040, line 40 . . . . . . . . . . . . . . . . . . . . . 29

30 If you elect to itemize deductions even though they are less than your standard deduction, check here . . . . . . . . . . . . . . . . . . . ▶

For Paperwork Reduction Act Notice, see Form 1040 instructions. Cat. No. 17145C Schedule A (Form 1040) 2010

other than gamblingcasualty or theft of income producing property

other investment interest

capital gains limited

deduction limited

Contributions not limited

Personal property taxes


SCHEDULE B (Form 1040A or 1040) 2010

Interest and Ordinary Dividends


▶ Attach to Form 1040A or 1040. ▶ See instructions on back.

OMB No. 1545-0074

Attachment Sequence No. 08

Name(s) shown on return Your social security number

Part I

Interest

(See instructions on back and the instructions for Form 1040A, or Form 1040, line 8a.) Note. If you received a Form 1099-INT, Form 1099-OID, or substitute statement from a brokerage firm, list the firm’s name as the payer and enter the total interest shown on that form.

1 List name of payer. If any interest is from a seller-financed mortgage and the buyer used the property as a personal residence, see instructions on back and list this interest first. Also, show that buyer’s social security number and address ▶

1

Amount

2 Add the amounts on line 1 . . . . . . . . . . . . . . . . . . 2 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989.

Attach Form 8815 . . . . . . . . . . . . . . . . . . . . . 3 4 Subtract line 3 from line 2. Enter the result here and on Form 1040A, or Form

1040, line 8a . . . . . . . . . . . . . . . . . . . . . . ▶ 4 Note. If line 4 is over $1,500, you must complete Part III. Amount

Part II

Ordinary Dividends (See instructions on back and the instructions for Form 1040A, or Form 1040, line 9a.)

Note. If you received a Form 1099-DIV or substitute statement from a brokerage firm, list the firm’s name as the payer and enter the ordinary dividends shown on that form.

5 List name of payer ▶

5

6 Add the amounts on line 5. Enter the total here and on Form 1040A, or Form 1040, line 9a . . . . . . . . . . . . . . . . . . . . . . ▶ 6

Note. If line 6 is over $1,500, you must complete Part III.

Part III Foreign Accounts and Trusts (See instructions on back.)

You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; (b) had a foreign account; or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust. Yes No

7 a At any time during 2010, did you have an interest in or a signature or other authority over a financial account in a foreign country, such as a bank account, securities account, or other financial account? See instructions on back for exceptions and filing requirements for Form TD F 90-22.1 . . . . .

b If “Yes,” enter the name of the foreign country ▶8 During 2010, did you receive a distribution from, or were you the grantor of, or transferor to, a

foreign trust? If “Yes,” you may have to file Form 3520. See instructions on back . . . . . .

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 17146N Schedule B (Form 1040A or 1040) 2010


SCHEDULE C (Form 1040)


Profit or Loss From Business (Sole Proprietorship)

▶ Partnerships, joint ventures, etc., generally must file Form 1065 or 1065-B. ▶ Attach to Form 1040, 1040NR, or 1041. ▶ See Instructions for Schedule C (Form 1040).

OMB No. 1545-0074


Name of proprietor Social security number (SSN)

A Principal business or profession, including product or service (see instructions) B Enter code from pages C-9, 10, & 11

▶

C Business name. If no separate business name, leave blank. D Employer ID number (EIN), if any

E Business address (including suite or room no.) ▶

City, town or post office, state, and ZIP code

F Accounting method: (1) Cash (2) Accrual (3) Other (specify) ▶

G Did you “materially participate” in the operation of this business during 2010? If “No,” see instructions for limit on losses Yes No

H If you started or acquired this business during 2010, check here . . . . . . . . . . . . . . . . . . . ▶

Part I Income 1 Gross receipts or sales. Caution. See instructions and check the box if:

• This income was reported to you on Form W-2 and the “Statutory employee” box on that form was checked, or

• You are a member of a qualified joint venture reporting only rental real estate income not subject to self-employment tax. Also see instructions for limit on losses.

} . . ▶

1

2 Returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Cost of goods sold (from line 42 on page 2) . . . . . . . . . . . . . . . . . . . 4

5 Gross profit. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . 5

6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . 6 7 Gross income. Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . ▶ 7

Part II Expenses. Enter expenses for business use of your home only on line 30. 8 Advertising . . . . . 8

9 Car and truck expenses (see instructions) . . . . . 9

10 Commissions and fees . 10

11 Contract labor (see instructions) 11

12 Depletion . . . . . 12

13 Depreciation and section 179 expense deduction (not included in Part III) (see instructions) . . . . . 13

14 Employee benefit programs (other than on line 19) . . 14

15 Insurance (other than health) 15

16 Interest:

a Mortgage (paid to banks, etc.) 16a

b Other . . . . . . 16b

17 Legal and professional services . . . . . . 17

18 Office expense . . . . . . 18

19 Pension and profit-sharing plans . 19

20 Rent or lease (see instructions):

a Vehicles, machinery, and equipment 20a

b Other business property . . . 20b

21 Repairs and maintenance . . . 21

22 Supplies (not included in Part III) . 22

23 Taxes and licenses . . . . . 23

24 Travel, meals, and entertainment:

a Travel . . . . . . . . . 24a

b Deductible meals and entertainment (see instructions) . 24b

25 Utilities . . . . . . . . 25

26 Wages (less employment credits) . 26

27 Other expenses (from line 48 on page 2) . . . . . . . . 27

28 Total expenses before expenses for business use of home. Add lines 8 through 27 . . . . . . ▶ 28

29 Tentative profit or (loss). Subtract line 28 from line 7 . . . . . . . . . . . . . . . . . 29

30 Expenses for business use of your home. Attach Form 8829 . . . . . . . . . . . . . . 30

31 Net profit or (loss). Subtract line 30 from line 29.

• If a profit, enter on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 (if you checked the box on line 1, see instructions). Estates and trusts, enter on Form 1041, line 3.

• If a loss, you must go to line 32.} 31

32 If you have a loss, check the box that describes your investment in this activity (see instructions).

• If you checked 32a, enter the loss on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13 (if you checked the box on line 1, see the line 31 instructions). Estates and trusts, enter on Form 1041, line 3.

• If you checked 32b, you must attach Form 6198. Your loss may be limited.

} 32a All investment is at risk.

32b Some investment is not at risk.

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11334P Schedule C (Form 1040) 2010

sex of the proprietor sex of the proprietor verification code

nondeductible loss suspended loss carryover

if name indicates LLC


Schedule C (Form 1040) 2010 Page 2 Part III Cost of Goods Sold (see instructions)

33 Method(s) used to value closing inventory: a Cost b Lower of cost or market c Other (attach explanation)

34 Was there any change in determining quantities, costs, or valuations between opening and closing inventory? If “Yes,” attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

35 Inventory at beginning of year. If different from last year’s closing inventory, attach explanation . . . 35

36 Purchases less cost of items withdrawn for personal use . . . . . . . . . . . . . . 36

37 Cost of labor. Do not include any amounts paid to yourself . . . . . . . . . . . . . . 37

38 Materials and supplies . . . . . . . . . . . . . . . . . . . . . . . . 38

39 Other costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

40 Add lines 35 through 39 . . . . . . . . . . . . . . . . . . . . . . . . 40

41 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 41

42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on page 1, line 4 . . . 42 Part IV Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 9

and are not required to file Form 4562 for this business. See the instructions for line 13 to find out if you must file Form 4562.

43 When did you place your vehicle in service for business purposes? (month, day, year) ▶ / /

44 Of the total number of miles you drove your vehicle during 2010, enter the number of miles you used your vehicle for:

a Business b Commuting (see instructions) c Other

45 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . . Yes No

46 Do you (or your spouse) have another vehicle available for personal use?. . . . . . . . . . . . . . Yes No

47a Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . . Yes No

b If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Part V Other Expenses. List below business expenses not included on lines 8–26 or line 30.

48 Total other expenses. Enter here and on page 1, line 27 . . . . . . . . . . . . . . 48

Schedule C (Form 1040) 2010


SCHEDULE C-EZ (Form 1040)


Net Profit From Business (Sole Proprietorship)

▶ Partnerships, joint ventures, etc., generally must file Form 1065 or 1065-B. ▶ Attach to Form 1040, 1040NR, or 1041. ▶ See instructions on page 2.

OMB No. 1545-0074

2010Attachment Sequence No. 09A


Part I General Information

You May Use Schedule C-EZ Instead of Schedule C Only If You:

▶ • Had business expenses of $5,000 or less.

• Use the cash method of accounting.

• Did not have an inventory at any time during the year.

• Did not have a net loss from your business.

• Had only one business as either a sole proprietor, qualified joint venture, or statutory employee.

And You:

▶• Had no employees during the year.

• Are not required to file Form 4562, Depreciation and Amortization, for this business. See the instructions for Schedule C, line 13, to find out if you must file.

• Do not deduct expenses for business use of your home.

• Do not have prior year unallowed passive activity losses from this business.

A Principal business or profession, including product or service B Enter business code (see page 2)

▶C Business name. If no separate business name, leave blank. D Enter your EIN (see page 2)

E Business address (including suite or room no.). Address not required if same as on page 1 of your tax return.


Part II Figure Your Net Profit

1 Gross receipts. Caution. See the instructions for Schedule C, line 1, and check the box if:• This income was reported to you on Form W-2 and the “Statutory employee” box on that form was checked, or

• You are a member of a qualified joint venture reporting only rental real estate income not subject to self-employment tax.

} . . . ▶ 1

2 Total expenses (see page 2). If more than $5,000, you must use Schedule C . . . . . . . 2

3

Net profit. Subtract line 2 from line 1. If less than zero, you must use Schedule C. Enter on both Form 1040, line 12, and Schedule SE, line 2, or on Form 1040NR, line 13. (If you checked thebox on line 1, do not report the amount from line 3 on Schedule SE, line 2.) Estates and trusts, enter on Form 1041, line 3 . . . . . . . . . . . . . . . . . . . . . . . . 3

Part III Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses on line 2.

4 When did you place your vehicle in service for business purposes? (month, day, year) ▶ .


a Business b Commuting (see page 2) c Other

6 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . Yes No

7 Do you (or your spouse) have another vehicle available for personal use? . . . . . . . . . . . Yes No

8a Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . Yes No

b If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . Yes NoFor Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 14374D Schedule C-EZ (Form 1040) 2010

sex of the proprietor

if name indicates LLC

sex of the proprietor verification code


SCHEDULE D (Form 1040)


Capital Gains and Losses

▶ Attach to Form 1040 or Form 1040NR. ▶ See Instructions for Schedule D (Form 1040). ▶ Use Schedule D-1 to list additional transactions for lines 1 and 8.

OMB No. 1545-0074



Part I Short-Term Capital Gains and Losses—Assets Held One Year or Less

(a) Description of property (Example: 100 sh. XYZ Co.)

(b) Date acquired (Mo., day, yr.)

(c) Date sold (Mo., day, yr.)

(d) Sales price (see page D-7 of the instructions)

(e) Cost or other basis (see page D-7 of the instructions)

(f) Gain or (loss) Subtract (e) from (d)

1

2 Enter your short-term totals, if any, from Schedule D-1, line 2 . . . . . . . . . . . . . . . . . 2

3 Total short-term sales price amounts. Add lines 1 and 2 in column (d) . . . . . . . . . . . . . . 3

4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 . 4 5 Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from

Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6 Short-term capital loss carryover. Enter the amount, if any, from line 10 of your Capital Loss

Carryover Worksheet on page D-7 of the instructions . . . . . . . . . . . . . . . 6 ( )

7 Net short-term capital gain or (loss). Combine lines 1 through 6 in column (f) . . . . . . . 7

Part II Long-Term Capital Gains and Losses—Assets Held More Than One Year







8

9 Enter your long-term totals, if any, from Schedule D-1, line 9 . . . . . . . . . . . . . . . . . 9

10 Total long-term sales price amounts. Add lines 8 and 9 in column (d). . . . . . . . . . . . . . 10

11 Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss) from Forms 4684, 6781, and 8824 . . . . . . . . . . . . . . . . . . . . 11

12 Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

13 Capital gain distributions. See page D-2 of the instructions . . . . . . . . . . . . . . 13 14 Long-term capital loss carryover. Enter the amount, if any, from line 15 of your Capital Loss


15 Net long-term capital gain or (loss). Combine lines 8 through 14 in column (f). Then go to Part III on the back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11338H Schedule D (Form 1040) 2010

nondeductible loss ST

nondeductible loss LT


Schedule D (Form 1040) 2010 Page 2

Part III Summary

16 Combine lines 7 and 15 and enter the result . . . . . . . . . . . . . . . . . . . 16

• If line 16 is a gain, enter the amount from line 16 on Form 1040, line 13, or Form 1040NR, line 14. Then go to line 17 below.

• If line 16 is a loss, skip lines 17 through 20 below. Then go to line 21. Also be sure to complete line 22.

• If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, line 13, or Form1040NR, line 14. Then go to line 22.

17 Are lines 15 and 16 both gains? Yes. Go to line 18. No. Skip lines 18 through 21, and go to line 22.

18 Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet on page D-8 of the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ 18

19 Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet on page D-9 of the instructions . . . . . . . . . . . . . . . . . . . . . . . . . ▶ 19

20 Are lines 18 and 19 both zero or blank?

Yes. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete theQualified Dividends and Capital Gain Tax Worksheet in the Instructions for Form 1040, line 44 (or in the Instructions for Form 1040NR, line 42). Do not complete lines 21 and 22 below.

No. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete theSchedule D Tax Worksheet on page D-10 of the instructions. Do not complete lines 21 and 22 below.

21 If line 16 is a loss, enter here and on Form 1040, line 13, or Form 1040NR, line 14, the smaller of:

• The loss on line 16 or • ($3,000), or if married filing separately, ($1,500) } . . . . . . . . . . . . . . . 21 ( )

Note. When figuring which amount is smaller, treat both amounts as positive numbers.

22 Do you have qualified dividends on Form 1040, line 9b, or Form 1040NR, line 10b?

Yes. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete theQualified Dividends and Capital Gain Tax Worksheet in the Instructions for Form 1040, line 44 (or in the Instructions for Form 1040NR, line 42). No. Complete the rest of Form 1040 or Form 1040NR.

Schedule D (Form 1040) 2010

undeterminable nondeductible


SCHEDULE E (Form 1040)


Supplemental Income and Loss (From rental real estate, royalties, partnerships,

S corporations, estates, trusts, REMICs, etc.)▶ Attach to Form 1040, 1040NR, or Form 1041. ▶ See Instructions for Schedule E (Form 1040).

OMB No. 1545-0074



Part I Income or Loss From Rental Real Estate and Royalties Note. If you are in the business of renting personal property, use Schedule C or C-EZ (see page E-3). If you are an individual, report farm rental income or loss from Form 4835 on page 2, line 40.

1 List the type and address of each rental real estate property:

A

B

C

2 For each rental real estate property listed on line 1, did you or your family use it during the tax year for personal purposes for more than the greater of: • 14 days or • 10% of the total days rented at fair

rental value? (See page E-3)

Yes No

A

B

C

Income: Properties Totals

(Add columns A, B, and C.) A B C

3 Rents received . . . . . . 3 3 4 Royalties received . . . . . 4 4

Expenses:

5 Advertising . . . . . . . 5 6 Auto and travel (see page E-4) . 6 7 Cleaning and maintenance . . 7 8 Commissions. . . . . . . 8 9 Insurance . . . . . . . . 9

10 Legal and other professional fees 10 11 Management fees . . . . . 11 12 Mortgage interest paid to

banks, etc. (see page E-5) . . 12 12 13 Other interest. . . . . . . 13 14 Repairs. . . . . . . . . 14 15 Supplies . . . . . . . . 15 16 Taxes . . . . . . . . . 16 17 Utilities . . . . . . . . . 17 18 Other (list) ▶

18

19 Add lines 5 through 18. . . . 19 19 20 Depreciation expense or

depletion (see page E-5) . . . 20 20 21 Total expenses. Add lines 19 and 20 21

22 Income or (loss) from rental real estate or royalty properties. Subtract line 21 from line 3 (rents) or line 4 (royalties). If the result is a (loss), see page E-5 to find out if you must file Form 6198 . . 22

23 Deductible rental real estate loss. Caution. Your rental real estate loss on line 22 may be limited. See page E-5 to find out if you must file Form 8582. Real estate professionals must complete line 43 on page 2 . 23 ( ) ( ) ( )

24 Income. Add positive amounts shown on line 22. Do not include any losses . . . . . . . 24 25 Losses. Add royalty losses from line 22 and rental real estate losses from line 23. Enter total losses here 25 ( )

26 Total rental real estate and royalty income or (loss). Combine lines 24 and 25. Enter the result here. If Parts II, III, IV, and line 40 on page 2 do not apply to you, also enter this amount on Form 1040, line 17, or Form 1040NR, line 18. Otherwise, include this amount in the total on line 41 on page 2 . . . . . . 26

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11344L Schedule E (Form 1040) 2010

number of rentals

number of royalties

RENTALROYALTIES

nondeductible rental loss

suspended loss carryover


Schedule E (Form 1040) 2010 Attachment Sequence No. 13 Page 2 Name(s) shown on return. Do not enter name and social security number if shown on other side. Your social security number

Caution. The IRS compares amounts reported on your tax return with amounts shown on Schedule(s) K-1.

Part II Income or Loss From Partnerships and S Corporations Note. If you report a loss from an at-risk activity for which any amount is not at risk, you must check the box in column (e) on line 28 and attach Form 6198. See page E-1.

27 Are you reporting any loss not allowed in a prior year due to the at-risk or basis limitations, a prior year unallowed loss from a passive activity (if that loss was not reported on Form 8582), or unreimbursedpartnership expenses? If you answered “Yes,” see page E-7 before completing this section.

Yes No

28 (a) Name (b) Enter P for partnership; S

for S corporation

(c) Check if foreign

partnership

(d) Employer identification

number

(e) Check if any amount is

not at risk

ABCD

Passive Income and Loss Nonpassive Income and Loss (f) Passive loss allowed

(attach Form 8582 if required)(g) Passive income from Schedule K–1

(h) Nonpassive loss from Schedule K–1

(i) Section 179 expense deduction from Form 4562

(j) Nonpassive income from Schedule K–1

ABCD

29a Totals b Totals

30 Add columns (g) and (j) of line 29a . . . . . . . . . . . . . . . . . . . . . . 30 31 Add columns (f), (h), and (i) of line 29b . . . . . . . . . . . . . . . . . . . . 31 ( )32 Total partnership and S corporation income or (loss). Combine lines 30 and 31. Enter the

result here and include in the total on line 41 below . . . . . . . . . . . . . . . . 32 Part III Income or Loss From Estates and Trusts

33 (a) Name (b) Employer

identification number

AB

Passive Income and Loss Nonpassive Income and Loss

(c) Passive deduction or loss allowed (attach Form 8582 if required)

(d) Passive income from Schedule K–1

(e) Deduction or loss from Schedule K–1

(f) Other income from Schedule K–1

AB

34a Totals b Totals

35 Add columns (d) and (f) of line 34a . . . . . . . . . . . . . . . . . . . . . 35 36 Add columns (c) and (e) of line 34b . . . . . . . . . . . . . . . . . . . . 36 ( )37 Total estate and trust income or (loss). Combine lines 35 and 36. Enter the result here and

include in the total on line 41 below . . . . . . . . . . . . . . . . . . . . 37 Part IV Income or Loss From Real Estate Mortgage Investment Conduits (REMICs)—Residual Holder

38 (a) Name (b) Employer identification number

(c) Excess inclusion from Schedules Q, line 2c

(see page E-8)

(d) Taxable income (net loss) from Schedules Q, line 1b

(e) Income from Schedules Q, line 3b

39 Combine columns (d) and (e) only. Enter the result here and include in the total on line 41 below 39 Part V Summary 40 Net farm rental income or (loss) from Form 4835. Also, complete line 42 below . . . . . . 40 41 Total income or (loss). Combine lines 26, 32, 37, 39, and 40. Enter the result here and on Form 1040, line 17, or Form 1040NR, line 18 ▶ 41 42 Reconciliation of farming and fishing income. Enter your gross

farming and fishing income reported on Form 4835, line 7; Schedule K-1 (Form 1065), box 14, code B; Schedule K-1 (Form 1120S), box 17, code U; and Schedule K-1 (Form 1041), line 14, code F (see page E-8) 42

43 Reconciliation for real estate professionals. If you were a real estate professional (see page E-2), enter the net income or (loss) you reported anywhere on Form 1040 or Form 1040NR from all rental real estate activities in which you materially participated under the passive activity loss rules . . 43

Schedule E (Form 1040) 2010

number of partnerships

number of s-corps

partnerships

s-corporations


SCHEDULE EIC (Form 1040A or 1040)


Earned Income CreditQualifying Child Information

Complete and attach to Form 1040A or 1040 only if you have a qualifying child.

1040A . . . . . . . . . .

1040

EIC

◀OMB No. 1545-0074



Before you begin:

▲!CAUTION

• See the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 64a and 64b, to make sure that (a) you can take the EIC, and (b) you have a qualifying child.

• Be sure the child’s name on line 1 and social security number (SSN) on line 2 agree with the child’s social security card. Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child’s social security card is not correct, call the Social Security Administration at 1-800-772-1213.

• If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See page 2 of schedule for details.

• It will take us longer to process your return and issue your refund if you do not fill in all lines that apply for each qualifying child.

Qualifying Child Information Child 1 Child 2 Child 3

1 Child’s name If you have more than three qualifying children, you only have to list three to get the maximum credit.

First name Last name First name Last name First name Last name

2 Child’s SSN The child must have an SSN as defined in the instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 64a and 64b,unless the child was born and died in 2010. If your child was born and died in 2010 and did not have an SSN, enter “Died” on this line and attach a copy of the child’s birth certificate, death certificate, or hospital medical records.

3 Child’s year of birth Year

If born after 1991 and the child was younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5.

Year If born after 1991 and the child was younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5.

Year If born after 1991 and the child was younger than you (or your spouse, if filing jointly), skip lines 4a and 4b; go to line 5.

4 a Was the child under age 24 at the end of 2010, a student, and younger than you (or your spouse, if filing jointly)?

Yes.

Go to line 5.

No.

Continue.

Yes.

Go to line 5.

No.

Continue.

Yes.

Go to line 5.

No.

Continue.

b Was the child permanently and totally disabled during any part of 2010?

Yes.

Continue.

No.The child is not a qualifying child.

Yes.Continue.


Yes.Continue.


5 Child’s relationship to you (for example, son, daughter, grandchild, niece, nephew, foster child, etc.)

6 Number of months child lived with you in the United States during 2010

• If the child lived with you for more than half of 2010 but less than 7 months, enter “7.”

• If the child was born or died in 2010 and your home was the child’s home for the entire time he or she was alive during 2010, enter “12.”

months Do not enter more than 12 months.



For Paperwork Reduction Act Notice, see your tax return instructions.

Cat. No. 13339M Schedule EIC (Form 1040A or 1040) 2010


SCHEDULE F (Form 1040)


Profit or Loss From Farming▶ Attach to Form 1040, Form 1040NR, Form 1041, Form 1065, or Form 1065-B.

▶ See Instructions for Schedule F (Form 1040).

OMB No. 1545-0074



A Principal product. Describe in one or two words your principal crop or activity for the current tax year. B Enter code from Part IV▶

C Accounting method: (1) Cash (2) Accrual

D Employer ID number (EIN), if any

E Did you “materially participate” in the operation of this business during 2010? If “No,” see instructions for limit on passive losses. Yes No

Part I Farm Income—Cash Method. Complete Parts I and II (Accrual method. Complete Parts II and III, and Part I, line 11.) Do not include sales of livestock held for draft, breeding, sport, or dairy purposes. Report these sales on Form 4797.

1 Sales of livestock and other items you bought for resale . . . . . . 1

2 Cost or other basis of livestock and other items reported on line 1 . . . 2


4 Sales of livestock, produce, grains, and other products you raised . . . . . . . . . . . . 4

5a Cooperative distributions (Form(s) 1099-PATR) . . 5a 5b Taxable amount 5b

6a Agricultural program payments (see instructions) 6a 6b Taxable amount 6b

7 Commodity Credit Corporation (CCC) loans (see instructions):

a CCC loans reported under election . . . . . . . . . . . . . . . . . . . . . . 7a

b CCC loans forfeited . . . . . . . . . 7b 7c Taxable amount 7c

8 Crop insurance proceeds and federal crop disaster payments (see instructions):

a Amount received in 2010 . . . . . . . 8a 8b Taxable amount 8b

c If election to defer to 2011 is attached, check here ▶ 8d Amount deferred from 2009 8d

9 Custom hire (machine work) income . . . . . . . . . . . . . . . . . . . . . 9

10 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) . . . . . 10

11 Gross income. Add amounts in the right column for lines 3 through 10. If you use the accrual method to figure your income, enter the amount from Part III, line 51 . . . . . . . . . . . . . . ▶ 11

Part II Farm Expenses—Cash and Accrual Method. Do not include personal or living expenses such as taxes, insurance, or repairs on your home.

12

Car and truck expenses (see

instructions). Also attach Form 4562 12

13 Chemicals . . . . . . 13

14 Conservation expenses (see instructions) 14

15 Custom hire (machine work) . 15

16

Depreciation and section 179 expense deduction not claimed elsewhere (see instructions) . 16

17

Employee benefit programs other

than on line 25 . . . . . 17

18 Feed . . . . . . . 18

19 Fertilizers and lime . . . 19

20 Freight and trucking . . . 20

21 Gasoline, fuel, and oil . . . 21


23 Interest:


b Other . . . . . . . 23b

24 Labor hired (less employment credits) 24

25 Pension and profit-sharing plans 25

26 Rent or lease (see instructions):

Vehicles, machinery, and equipment . . . . . . .

a 26a

b Other (land, animals, etc.) . . 26b

27 Repairs and maintenance . . 27

28 Seeds and plants . . . . . 28

29 Storage and warehousing . . 29

30 Supplies . . . . . . . 30

31 Taxes . . . . . . . . 31

32 Utilities . . . . . . . . 32

33 Veterinary, breeding, and medicine 33

34 Other expenses (specify):

a 34a

b 34b

c 34c

d 34d

e 34e

f

35 Total expenses. Add lines 12 through 34f. If line 34f is negative, see instructions . . . . . . . ▶ 35

36 Net farm profit or (loss). Subtract line 35 from line 11. Partnerships, see instructions.

}• If a profit, enter the profit on both Form 1040, line 18, and Schedule SE, line 1a; on Form 1040NR, line 19; or on Form 1041, line 6. 36

• If a loss, you must go to line 37.

37

If you have a loss, you must check the box that describes your investment in this activity and whether you

received any applicable subsidy (see instructions). }• If you checked 37a, enter the loss on both Form 1040, line 18, and Schedule SE, line 1a; on Form 1040NR, line 19; or on Form 1041, line 6.

37a All investment is at risk and you did not receive a subsidy.

37b Some investment is not at risk or you received a subsidy.• If you checked 37b, your loss may be limited. See instructions.

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11346H Schedule F (Form 1040) 2010

sex of proprietor

Other expenses

Nondeductible Loss (+)/Suspended Carryover (-)

Nondeductible Loss (+)/Suspended Carryover (-) 4


Schedule F (Form 1040) 2010 Page 2Part III Farm Income—Accrual Method (see instructions).

Do not include sales of livestock held for draft, breeding, sport, or dairy purposes. Report these sales on Form 4797 and do not include this livestock on line 46 below.

38 Sales of livestock, produce, grains, and other products . . . . . . . . . . . . . . . . 38


40a Agricultural program payments . . . . . . 40a 40b Taxable amount 40b

41 Commodity Credit Corporation (CCC) loans:



42 Crop insurance proceeds . . . . . . . . . . . . . . . . . . . . . . . . 42


44 Other income, including federal and state gasoline or fuel tax credit or refund . . . . . . . . . 44

45 Add amounts in the right column for lines 38 through 44 . . . . . . . . . . . . . . . 45

46

Inventory of livestock, produce, grains, and other products at beginning of the year . . . . . . . . . . . . . . . . . . . . . 46

47

Cost of livestock, produce, grains, and other products purchased during the year . . . . . . . . . . . . . . . . . . . . . . 47

48 Add lines 46 and 47 . . . . . . . . . . . . . . . . . 48

49 Inventory of livestock, produce, grains, and other products at end of year . 49

50 Cost of livestock, produce, grains, and other products sold. Subtract line 49 from line 48* . . . . . 50

51 Gross income. Subtract line 50 from line 45. Enter the result here and on Part I, line 11 . . . . . ▶ 51

*If you use the unit-livestock-price method or the farm-price method of valuing inventory and the amount on line 49 is larger than the amount on line 48, subtract line 48 from line 49. Enter the result on line 50. Add lines 45 and 50. Enter the total on line 51 and on Part I, line 11.

Part IV Principal Agricultural Activity Codes

▲!CAUTION

File Schedule C (Form 1040) or Schedule C-EZ (Form 1040) instead of Schedule F if (a) your principal source of income is from providing agricultural services such as soil preparation, veterinary, farm

labor, horticultural, or management for a fee or on a contract basis, or (b) you are engaged in the business of breeding, raising, and caring for dogs, cats, or other pet animals.

These codes for the Principal Agricultural Activity classify farms by their primary activity to facilitate the administration of the Internal Revenue Code. These six-digit codes are based on the North American Industry Classification System (NAICS).

Select the code that best identifies your primary farming activity and enter the six digit number on page 1, line B.

Crop Production111100 Oilseed and grain farming111210 Vegetable and melon farming

111300 Fruit and tree nut farming111400 Greenhouse, nursery, and floriculture production111900 Other crop farming

Animal Production112111 Beef cattle ranching and farming112112 Cattle feedlots112120 Dairy cattle and milk production112210 Hog and pig farming112300 Poultry and egg production112400 Sheep and goat farming112510 Aquaculture112900 Other animal production

Forestry and Logging113000 Forestry and logging (including forest nurseries and

timber tracts)

Schedule F (Form 1040) 2010


SCHEDULE H (Form 1040)


Household Employment Taxes(For Social Security, Medicare, Withheld Income, and Federal Unemployment (FUTA) Taxes)

▶ Attach to Form 1040, 1040NR, 1040-SS, or 1041.▶ See separate instructions.

OMB No. 1545-1971


Name of employer Social security number

Employer identification number

A Did you pay any one household employee cash wages of $1,700 or more in 2010? (If any household employee was your spouse, your child under age 21, your parent, or anyone under age 18, see the line A instructions on page H-4 before you answer this question.)

Yes. Skip lines B and C and go to line 1.No. Go to line B.

B Did you withhold federal income tax during 2010 for any household employee?

Yes. Skip line C and go to line 5.No. Go to line C.

C Did you pay total cash wages of $1,000 or more in any calendar quarter of 2009 or 2010 to all household employees? (Do not count cash wages paid in 2009 or 2010 to your spouse, your child under age 21, or your parent.)

No. Stop. Do not file this schedule. Yes. Skip lines 1-9 and go to line 10 on the back. (Calendar year taxpayers having no household employees in

2010 do not have to complete this form for 2010.)

Part I Social Security, Medicare, and Federal Income Taxes

1 Total cash wages subject to social security taxes (see page H-4) . . 1

2 Social security taxes. Multiply line 1 by 12.4% (.124) . . . . . . . . . . . . . . . 2

3 Total cash wages subject to Medicare taxes (see page H-4) . . . . 3

4 Medicare taxes. Multiply line 3 by 2.9% (.029) . . . . . . . . . . . . . . . . . 4

5 Federal income tax withheld, if any . . . . . . . . . . . . . . . . . . . . . 5

6 Total social security, Medicare, and federal income taxes. Add lines 2, 4, and 5 . . . . . 6

7 Advance earned income credit (EIC) payments, if any . . . . . . . . . . . . . . . 7

8 Net taxes (subtract line 7 from line 6) . . . . . . . . . . . . . . . . . . . . 8

9 Did you pay total cash wages of $1,000 or more in any calendar quarter of 2009 or 2010 to all household employees? (Do not count cash wages paid in 2009 or 2010 to your spouse, your child under age 21, or your parent.)

No. Stop. Include the amount from line 8 above on Form 1040, line 59, and check box b on that line. If you are not required to file Form 1040, see the line 9 instructions on page H-4.

Yes. Go to line 10 on the back.

For Privacy Act and Paperwork Reduction Act Notice, see page H-7 of the instructions. Cat. No. 12187K Schedule H (Form 1040) 2010


Schedule H (Form 1040) 2010 Page 2 Part II Federal Unemployment (FUTA) Tax

Yes No 10 Did you pay unemployment contributions to only one state? (If you paid contributions to a credit reduction

state, see page H-5 and check "No.") . . . . . . . . . . . . . . . . . . . . . . . . 10 11 Did you pay all state unemployment contributions for 2010 by April 18, 2011? Fiscal year filers, see page H-5 11 12 Were all wages that are taxable for FUTA tax also taxable for your state’s unemployment tax? . . . . . 12

Next: If you checked the “Yes” box on all the lines above, complete Section A. If you checked the “No” box on any of the lines above, skip Section A and complete Section B.

Section A 13 Name of the state where you paid unemployment contributions ▶

14 Contributions paid to your state unemployment fund (see page H-5) . 1415 Total cash wages subject to FUTA tax (see page H-5) . . . . . . . . . . . . . . . 15

16 FUTA tax. Multiply line 15 by .008. Enter the result here, skip Section B, and go to line 25 . . . 16Section B

17 Complete all columns below that apply (if you need more space, see page H-5):

(a) Name

of state

(b) Taxable wages (as defined in state act)

(c) State experience rate

period

From To

(d) State

experience rate

(e) Multiply col. (b)

by .054

(f) Multiply col. (b)

by col. (d)

(g) Subtract col. (f) from col. (e). If zero or less,

enter -0-.

(h) Contributions paid to state

unemployment fund

18 Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1819 Add columns (g) and (h) of line 18 . . . . . . . . . . . . 1920 Total cash wages subject to FUTA tax (see the line 15 instructions on page H-5) . . . . . . 2021 Multiply line 20 by 6.2% (.062) . . . . . . . . . . . . . . . . . . . . . . 2122 Multiply line 20 by 5.4% (.054) . . . . . . . . . . . . . 2223 Enter the smaller of line 19 or line 22 . . . . . . . . . . . . . . . . . . . .

(Employers in a credit reduction state must use the worksheet on page H-5 and check here) . 2324 FUTA tax. Subtract line 23 from line 21. Enter the result here and go to line 25 . . . . . . 24Part III Total Household Employment Taxes 25 Enter the amount from line 8. If you checked the “Yes” box on line C of page 1, enter -0- . . . 2526 Add line 16 (or line 24) and line 25 (see page H-6) . . . . . . . . . . . . . . . . 2627 Are you required to file Form 1040?

Yes. Stop. Include the amount from line 26 above on Form 1040, line 59, and check box b on that line. Do not complete Part IV below.

No. You may have to complete Part IV. See page H-6 for details.Part IV Address and Signature— Complete this part only if required. See the line 27 instructions on page H-6.

Address (number and street) or P.O. box if mail is not delivered to street address Apt., room, or suite no.


Under penalties of perjury, I declare that I have examined this schedule, including accompanying statements, and to the best of my knowledge and belief, it is true,correct, and complete. No part of any payment made to a state unemployment fund claimed as a credit was, or is to be, deducted from the payments to employees. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

▲

Employer’s signature

▲

Date


Print/Type preparer’s name Preparer's signature DateCheck if self-employed

PTIN

Firm’s name ▶

Firm's address ▶

Firm's EIN ▶

Phone no.

Schedule H (Form 1040) 2010


SCHEDULE J (Form 1040)


Income Averaging for Farmers and Fishermen▶ Attach to Form 1040 or Form 1040NR.

▶ See Instructions for Schedule J (Form 1040).

OMB No. 1545-0074


Name(s) shown on return Social security number (SSN)

1 Enter the taxable income from your 2010 Form 1040, line 43, or Form 1040NR, line 41 . . . 1

2a Enter your elected farm income (see page J-2). Do not enter more than the amount on line 1 . 2a

Capital gain included on line 2a:

b Excess, if any, of net long-term capital gain over net short-term capital loss . . . . . . . . . . . . . . . . . 2b

c Unrecaptured section 1250 gain . . . . . . . . . . 2c

3 Subtract line 2a from line 1 . . . . . . . . . . . . . . . . . . . . . . . 3

4 Figure the tax on the amount on line 3 using the 2010 tax rates (see page J-2) . . . . . . 4

5 If you used Schedule J to figure your tax for:

• 2009, enter the amount from your 2009 Schedule J, line 11. • 2008 but not 2009, enter the amount from your 2008 Schedule J, line 15. • 2007 but not 2008 or 2009, enter the amount from your 2007

Schedule J, line 3. Otherwise, enter the taxable income from your 2007 Form 1040, line 43; Form 1040A, line 27; Form 1040EZ, line 6; Form 1040NR, line 40; or Form 1040NR-EZ, line 14. If zero or less, see page J-2.

} 5

6 Divide the amount on line 2a by 3.0 . . . . . . . . . 6

7 Combine lines 5 and 6. If zero or less, enter -0- . . . . . 7


9 If you used Schedule J to figure your tax for: • 2009, enter the amount from your 2009 Schedule J, line 15. • 2008 but not 2009, enter the amount from your 2008 Schedule J, line 3. Otherwise, enter the taxable income from your 2008 Form 1040, line 43; Form 1040A, line 27; Form 1040EZ, line 6; Form 1040NR, line 40; or Form 1040NR-EZ, line 14. If zero or less, see page J-7.

} 9

10 Enter the amount from line 6 . . . . . . . . . . . 10

11 Combine lines 9 and 10. If less than zero, enter as a negative amount 11


13 If you used Schedule J to figure your tax for 2009, enter the amount from your 2009 Schedule J, line 3. Otherwise, enter the taxable income from your 2009 Form 1040, line 43; Form 1040A, line 27; Form 1040EZ, line 6; Form 1040NR, line 40; or Form 1040NR-EZ, line 14. If zero or less, see page J-11. 13

14 Enter the amount from line 6 . . . . . . . . . . . 14

15 Combine lines 13 and 14. If less than zero, enter as a negative amount 15

16 Figure the tax on the amount on line 15 using the 2009 tax rates (see page J-12) . . . . . 16

17 Add lines 4, 8, 12, and 16 . . . . . . . . . . . . . . . . . . . . . . . 17For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 25513Y Schedule J (Form 1040) 2010


Schedule J (Form 1040) 2010 Page 218 Amount from line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . 18

19 If you used Schedule J to figure your tax for: • 2009, enter the amount from your 2009 Schedule J, line 12. • 2008 but not 2009, enter the amount from your 2008 Schedule J,

line 16. • 2007 but not 2008 or 2009, enter the amount from your 2007

Schedule J, line 4.

Otherwise, enter the tax from your 2007 Form 1040, line 44;* Form 1040A, line 28;* Form 1040EZ, line 10; Form 1040NR, line 41;* or Form 1040NR-EZ, line 15.

} 19

20 If you used Schedule J to figure your tax for: • 2009, enter the amount from your 2009 Schedule J, line 16. • 2008 but not 2009, enter the amount from your 2008 Schedule J,

line 4. Otherwise, enter the tax from your 2008 Form 1040, line 44;* Form 1040A, line 28;* Form 1040EZ, line 11; Form 1040NR, line 41;* or Form 1040NR-EZ, line 15.

} 20

21 If you used Schedule J to figure your tax for 2009, enter the amount from your 2009 Schedule J, line 4. Otherwise, enter the tax from your 2009 Form 1040, line 44;* Form 1040A, line 28;* Form 1040EZ, line 11; Form 1040NR, line 41;* or Form 1040NR-EZ, line 15 . . 21

*Do not include any tax reported on this line from Forms 8814, 4972, or 8889, or from recapture of an education credit or charitable contribution deduction. Also, do not include alternative minimum tax from Form 1040A.


23 Tax. Subtract line 22 from line 18. Also include this amount on Form 1040, line 44 or Form 1040NR, line 42 23

Caution. Your tax may be less if you figure it using the 2010 Tax Table, Tax Computation Worksheet, Qualified Dividends and Capital Gain Tax Worksheet, or Schedule D Tax Worksheet. Attach Schedule J only if you are using it to figure your tax.

Schedule J (Form 1040) 2010


SCHEDULE L (Form 1040A or 1040)


Standard Deduction for Certain Filers

▶ Attach to Form 1040A or 1040. ▶ See instructions on back.

OMB No. 1545-0074



▲!CAUTION

File this form only if you are increasing your standard deduction by certain net disaster losses or new motor vehicle taxes paid in 2010 for certain vehicles purchased in 2009.

1 Enter the amount shown below for your filing status.• Single or married filing separately—$5,700• Married filing jointly or Qualifying widow(er)—$11,400 . .• Head of household—$8,400

} 1

2 Can you (or your spouse if filing jointly) be claimed as a dependent on someone else’s return?

No. Enter the amount from line 1 on line 4, skip line 3, and go to line 5.

Yes. Go to line 3.3 Is your earned income more than $650 (see instructions)?

Yes. Add $300 to your earned income. Enter the total . .No. Enter $950 } 3

4 Enter the smaller of line 1 or line 3 . . . . . . . . . . . . . . . . . . . . 45 Multiply the number on Form 1040, line 39a, or Form 1040A, line 23a, by $1,100 ($1,400 if single

or head of household). If blank, enter -0- . . . . . . . . . . . . . . . . . . 56 Form 1040 filers only, enter from your 2010 Form 4684, line 17, any loss from a disaster

declared a federal disaster after 2007 that occurred before 2010 (see instructions) . . . . . 67 Did you (or your spouse if filing jointly) pay any state or local sales or excise taxes in 2010 for the

purchase of any new motor vehicle(s) after February 16, 2009, and before January 1, 2010 (see instructions)?

No. Skip lines 7 through 16, enter -0- on line 17, and go to line 18.Yes. If Form 1040, line 38, or Form 1040A, line 22, is less than $135,000 ($260,000 if married filing jointly), enter the amount of these taxes paid. Otherwise, skip lines 7 through 16, enter -0- on line 17, and go to line 18 7

8 Enter the purchase price (before taxes) of the new motor vehicle(s) (see instructions) . . . . . . . . . . . . . . . . 8

9 Is the amount on line 8 more than $49,500?No. Enter the amount from line 7.Yes. Figure the portion of the tax from line 7 that is attributable to the first $49,500 of the purchase price of each new motor vehicle and enter it here (see instructions) . . 9

10 Enter the amount from Form 1040, line 38, or Form 1040A, line 22 1011 Form 1040 filers only, enter the total of any—

• Amounts from Form 2555, lines 45 and 50; Form 2555-EZ, line 18; and Form 4563, line 15, and

• Exclusion of income from Puerto Rico . . . . . . . . . 1112 Add lines 10 and 11 . . . . . . . . . . . . . . . 1213 Enter $125,000 ($250,000 if married filing jointly) . . . . . . 1314 Is the amount on line 12 more than the amount on line 13?

No. Skip lines 14 through 16, enter the amount from line 9 on line 17, and go to line 18.

Yes. Subtract line 13 from line 12 . . . . . . . . . 1415

Divide the amount on line 14 by $10,000. Enter the result as a decimal (rounded to at least three places). If the result is 1.000 or more, enter 1.000 . . . . . . . . . . . . . . . . 15 .

16 Multiply line 9 by line 15 . . . . . . . . . . . . . . 1617 Subtract line 16 from line 9 . . . . . . . . . . . . . . . . . . . . . . . 1718 Add lines 4, 5, 6, and 17. Enter the total here and on Form 1040, line 40, or Form 1040A, line 24. 18

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 49875F Schedule L (Form 1040A or 1040) 2010

Form 1040 Filers Only: It may be better for you to itemize your deductions instead. See the Instructions for Schedule A (Form 1040).

Real estate tax


SCHEDULE M (Form 1040A or 1040)


Making Work Pay Credit

▶ Attach to Form 1040A or 1040. ▶ See separate instructions.

OMB No. 1545-0074



1

(e) You are filing Form 2555 or 2555-EZ.

a

Important: Check the “No” box on line 1a and see the instructions if:

Do you (and your spouse if filing jointly) have 2010 wages of more than $6,451 ($12,903 if married filing jointly)?Yes. Skip lines 1a through 3. Enter $400 ($800 if married filing jointly) on line 4 and go to line 5.No. Enter your earned income (see instructions) . . . . . . . 1a

b Nontaxable combat pay included on line 1a (see instructions) . . . . . . . . . 1b

2 Multiply line 1a by 6.2% (.062) . . . . . . . . . . . . . . 2

3 Enter $400 ($800 if married filing jointly) . . . . . . . . . . . 3

Enter the smaller of line 2 or line 3 (unless you checked “Yes” on line 1a) . . . . . . . . . 4

5 Enter the amount from Form 1040, line 38*, or Form 1040A, line 22 . . 5

6 Enter $75,000 ($150,000 if married filing jointly) . . . . . . . . 6

7 Is the amount on line 5 more than the amount on line 6?No. Skip line 8. Enter the amount from line 4 on line 9 below.Yes. Subtract line 6 from line 5 . . . . . . . . . . . . 7

8 Multiply line 7 by 2% (.02) . . . . . . . . . . . . . . . . . . . . . . . . 8

9 Subtract line 8 from line 4. If zero or less, enter -0- . . . . . . . . . . . . . . . .

10 Did you (or your spouse, if filing jointly) receive an economic recovery payment in 2010? You mayhave received this payment in 2010 if you did not receive an economic recovery payment in 2009 but you received social security benefits, supplemental security income, railroad retirement benefits, or veterans disability compensation or pension benefits in November 2008, December 2008, or January 2009 (see instructions).

No. Enter -0- on line 10 and go to line 11.Yes. Enter the total of the payments you (and your spouse, if filing jointly) received in 2010. Do

not enter more than $250 ($500 if married filing jointly) . . . . . . . . . . . . 10

11 Making work pay credit. Subtract line 10 from line 9. If zero or less, enter -0-. Enter the result here and on Form 1040, line 63; or Form 1040A, line 40 . . . . . . . . . . . . . . 11*If you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico, see instructions.

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 52903Q Schedule M (Form 1040A or 1040) 2010

(a) You have a net loss from a business, (b) You received a taxable scholarship or fellowship grant not reported on a Form W-2, (c) Your wages include pay for work performed while an inmate in a penal institution,

▲!CAUTION

To take the making work pay credit, you must include your social security number (if filing a joint return, the number of either you or your spouse) on your tax return. A social security number does not include an identification number issued by the IRS. Only the Social Security Administration issues social security numbers.

(d) You received a pension or annuity from a nonqualified deferred compensation plan or a nongovernmental section 457 plan, or

▲!CAUTION

You cannot take the making work pay credit if you can be claimed as someone else's dependent or if you are a nonresident alien.

9

(*)

4


Schedule R (Form 1040A or 1040)


Credit for the Elderly or the Disabled

Complete and attach to Form 1040A or 1040.

1040A . . . . . . . . . .

1040 R

◀OMB No. 1545-0074


Name(s) shown on Form 1040A or 1040 Your social security number

You may be able to take this credit and reduce your tax if by the end of 2010:• You were age 65 or older or

• You were under age 65, you retired on permanent and total disability, and you received taxable disability income.

But you must also meet other tests. See page R-1 of the instructions.

TIP In most cases, the IRS can figure the credit for you. See page R-1 of the instructions.

Part I Check the Box for Your Filing Status and AgeIf your filing status is: And by the end of 2010: Check only one box:

Single, Head of household, or Qualifying widow(er)

1 You were 65 or older . . . . . . . . . . . . . . . . . . . . 1

2 You were under 65 and you retired on permanent and total disability . . 2

Married filing jointly

3 Both spouses were 65 or older . . . . . . . . . . . . . . . . . 3

4 Both spouses were under 65, but only one spouse retired on permanent and total disability . . . . . . . . . . . . . . . . . . . . . . . 4

5 Both spouses were under 65, and both retired on permanent and total disability . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 One spouse was 65 or older, and the other spouse was under 65 and retired on permanent and total disability . . . . . . . . . . . . . . . . 6

7 One spouse was 65 or older, and the other spouse was under 65 and not retired on permanent and total disability . . . . . . . . . . . . . 7

Married filing separately

8 You were 65 or older and you lived apart from your spouse for all of 2010 . 8

9 You were under 65, you retired on permanent and total disability, and you lived apart from your spouse for all of 2010 . . . . . . . . . . . . 9

Did you check box 1, 3, 7, or 8?

Yes ▶ Skip Part II and complete Part III on the back.

No ▶ Complete Parts II and III.

Part II Statement of Permanent and Total Disability (Complete only if you checked box 2, 4, 5, 6, or 9 above.)

If: 1 You filed a physician’s statement for this disability for 1983 or an earlier year, or you filed or got a statement for tax years after 1983 and your physician signed line B on the statement, and

2 Due to your continued disabled condition, you were unable to engage in any substantial gainful activity in 2010, check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

• If you checked this box, you do not have to get another statement for 2010.

• If you did not check this box, have your physician complete the statement on page R-4 of the instructions. You must keep the statement for your records.

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11359K Schedule R (Form 1040A or 1040) 2010


Schedule R (Form 1040A or 1040) 2010 Page 2 Part III Figure Your Credit10 If you checked (in Part I): Enter:

Box 1, 2, 4, or 7 . . . . . . . . . . . . $5,000Box 3, 5, or 6 . . . . . . . . . . . . . $7,500Box 8 or 9 . . . . . . . . . . . . . . $3,750

} . . . . . . . . . . 10

Did you check box 2, 4, 5, 6, or 9 in Part I?

Yes ▶ You must complete line 11.

No ▶ Enter the amount from line 10 on line 12 and go to line 13.11 If you checked (in Part I):

• Box 6, add $5,000 to the taxable disability income of the spouse who was under age 65. Enter the total.

• Box 2, 4, or 9, enter your taxable disability income.• Box 5, add your taxable disability income to your spouse’s

taxable disability income. Enter the total.} . . . . . . . 11

TIP For more details on what to include on line 11, see page R-2.

12 If you completed line 11, enter the smaller of line 10 or line 11. All others, enter the amount from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . 12

13 Enter the following pensions, annuities, or disability income that you (and your spouse if filing jointly) received in 2010.

a Nontaxable part of social security benefits and nontaxable part of railroad retirement benefits treated as social security (see page R-3 of the instructions). . . . . . . . . . . . . . 13a

b Nontaxable veterans’ pensions and any other pension, annuity, or disability benefit that is excluded from income under any other provision of law (see page R-3 of the instructions) . . . 13b

c Add lines 13a and 13b. (Even though these income items are not taxable, they must be included here to figure your credit.) If you did not receive any of the types of nontaxable income listed on line 13a or 13b, enter -0- on line 13c . . . . . . . . . 13c

14 Enter the amount from Form 1040A, line 22, or Form 1040, line 38 . . . . . 14

15 If you checked (in Part I): Enter:Box 1 or 2 . . . . . . $7,500Box 3, 4, 5, 6, or 7 . . . $10,000Box 8 or 9 . . . . . . $5,000

} 15

16 Subtract line 15 from line 14. If zero or less, enter -0- . . . . . . . . . 16

17 Enter one-half of line 16 . . . . . . . . . . . . . . . 17

18 Add lines 13c and 17 . . . . . . . . . . . . . . . . . . . . . . . . . 1819 Subtract line 18 from line 12. If zero or less, stop; you cannot take the credit. Otherwise,

go to line 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1920 Multiply line 19 by 15% (.15). . . . . . . . . . . . . . . . . . . . . . . 2021 Tax liability limit. Enter the amount from the Credit Limit Worksheet on page R-3 of the

instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2122 Credit for the elderly or the disabled. Enter the smaller of line 20 or line 21. Also enter

this amount on Form 1040A, line 30, or include on Form 1040, line 53 (check box c and enter "Sch R" on the line next to that box) . . . . . . . . . . . . . . . . . 22

Schedule R (Form 1040A or 1040) 2010


SCHEDULE SE (Form 1040)


Self-Employment Tax

▶ Attach to Form 1040 or Form 1040NR. ▶ See Instructions for Schedule SE (Form 1040).

OMB No. 1545-0074


Name of person with self-employment income (as shown on Form 1040) Social security number of person with self-employment income ▶

Before you begin: To determine if you must file Schedule SE, see the instructions on page SE-1.

May I Use Short Schedule SE or Must I Use Long Schedule SE?

Note. Use this flowchart only if you must file Schedule SE. If unsure, see Who Must File Schedule SE on page SE-1.

Did you receive wages or tips in 2010?

No

▼

Are you a minister, member of a religious order, or Christian Science practitioner who received IRS approval not to be taxed on earnings from these sources, but you owe self-employment tax on other earnings?

Yes▶

No▼

Are you using one of the optional methods to figure your net earnings (see page SE-5)?

Yes▶

No▼

Did you receive church employee income (see page SE-1) reported on Form W-2 of $108.28 or more?

Yes▶

No▼

You may use Short Schedule SE below

Yes

▼

Was the total of your wages and tips subject to social security or railroad retirement (tier 1) tax plus your net earnings from self-employment more than $106,800?

Yes▶

No▼

Did you receive tips subject to social security or Medicare tax that you did not report to your employer?

Yes▶

No▼

Did you report any wages on Form 8919, Uncollected Social Security and Medicare Tax on Wages?

Yes▶

▶ You must use Long Schedule SE on page 2

▼

No ◀

▼

Section A—Short Schedule SE. Caution. Read above to see if you can use Short Schedule SE.

1a Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K-1 (Form 1065), box 14, code A . . . . . . . . . . . . . . . . . . . . . . . . 1a

b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F, line 6b, or listed on Schedule K-1 (Form 1065), box 20, code Y 1b ( )

2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1. Ministers and members of religious orders, see page SE-1 for types of income to report on thisline. See page SE-3 for other income to report . . . . . . . . . . . . . . . . 2

3 Combine lines 1a, 1b, and 2. Subtract from that total the amount on Form 1040, line 29, or Form 1040NR, line 29, and enter the result (see page SE-3) . . . . . . . . . . . 3

4 Multiply line 3 by 92.35% (.9235). If less than $400, you do not owe self-employment tax; do not file this schedule unless you have an amount on line 1b . . . . . . . . . . . ▶ 4 Note. If line 4 is less than $400 due to Conservation Reserve Program payments on line 1b, see page SE-3.

5 Self-employment tax. If the amount on line 4 is: • $106,800 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 56, or Form 1040NR, line 54 • More than $106,800, multiply line 4 by 2.9% (.029). Then, add $13,243.20 to the result. Enter the total here and on Form 1040, line 56, or Form 1040NR, line 54 . . . . . . . 5

6 Deduction for one-half of self-employment tax. Multiply line 5 by 50% (.50). Enter the result here and on Form 1040, line 27, or Form 1040NR, line 27 . . . . . . . . . . . . . 6

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11358Z Schedule SE (Form 1040) 2010


Schedule SE (Form 1040) 2010 Attachment Sequence No. 17 Page 2 Name of person with self-employment income (as shown on Form 1040) Social security number of person

with self-employment income ▶

Section B—Long Schedule SE

Part I Self-Employment Tax Note. If your only income subject to self-employment tax is church employee income, see page SE-3 for specific instructions. Also see page SE-1 for the definition of church employee income.

A If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you had $400 or more of other net earnings from self-employment, check here and continue with Part I . . . . . . ▶

1a Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K-1 (Form 1065), box 14, code A. Note. Skip lines 1a and 1b if you use the farm optional method (see page SE-5) 1a

b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments included on Schedule F, line 6b, or listed on Schedule K-1 (Form 1065), box 20, code Y 1b ( )

2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code J1. Ministers and members of religious orders, see page SE-1 for types of income to report on thisline. See page SE-4 for other income to report. Note. Skip this line if you use the nonfarmoptional method (see page SE-5) . . . . . . . . . . . . . . . . . . . . 2

3 Combine lines 1a, 1b, and 2. Subtract from that total the amount on Form 1040, line 29, or Form 1040NR, line 29, and enter the result (see page SE-3) . . . . . . . . . . . 3

4 a If line 3 is more than zero, multiply line 3 by 92.35% (.9235). Otherwise, enter amount from line 3 4a Note. If line 4a is less than $400 due to Conservation Reserve Program payments on line 1b, see page SE-3.

b If you elect one or both of the optional methods, enter the total of lines 15 and 17 here . . 4b c Combine lines 4a and 4b. If less than $400, stop; you do not owe self-employment tax.

Exception. If less than $400 and you had church employee income, enter -0- and continue ▶ 4c 5 a Enter your church employee income from Form W-2. See

page SE-1 for definition of church employee income . . . . 5a b Multiply line 5a by 92.35% (.9235). If less than $100, enter -0- . . . . . . . . . . 5b

6 Add lines 4c and 5b . . . . . . . . . . . . . . . . . . . . . . . . 6 7 Maximum amount of combined wages and self-employment earnings subject to social security

or the 6.2% portion of the 7.65% railroad retirement (tier 1) tax for 2010 . . . . . . 7 106,800 008 a Total social security wages and tips (total of boxes 3 and 7 on

Form(s) W-2) and railroad retirement (tier 1) compensation. If $106,800 or more, skip lines 8b through 10, and go to line 11 8a

b Unreported tips subject to social security tax (from Form 4137, line 10) 8b c Wages subject to social security tax (from Form 8919, line 10) 8c d Add lines 8a, 8b, and 8c . . . . . . . . . . . . . . . . . . . . . . . 8d

9 Subtract line 8d from line 7. If zero or less, enter -0- here and on line 10 and go to line 11 . ▶ 9 10 Multiply the smaller of line 6 or line 9 by 12.4% (.124) . . . . . . . . . . . . . 10 11 Multiply line 6 by 2.9% (.029) . . . . . . . . . . . . . . . . . . . . . 11 12 Self-employment tax. Add lines 10 and 11. Enter here and on Form 1040, line 56, or Form 1040NR, line 54 12 13 Deduction for one-half of self-employment tax. Multiply line 12 by 50% (.50).

Enter the result here and on Form 1040, line 27, or Form 1040NR, line 27 . 13 Part II Optional Methods To Figure Net Earnings (see page SE-4)

Farm Optional Method. You may use this method only if (a) your gross farm income1 was not more

than $6,720, or (b) your net farm profits2 were less than $4,851.

14 Maximum income for optional methods . . . . . . . . . . . . . . . . . . 14 4,480 00 15 Enter the smaller of: two-thirds (2/3) of gross farm income1 (not less than zero) or $4,480. Also

include this amount on line 4b above . . . . . . . . . . . . . . . . . . . 15 Nonfarm Optional Method. You may use this method only if (a) your net nonfarm profits3

were less than $4,851 and also less than 72.189% of your gross nonfarm income,4

and (b) you had net earnings from self-employment of at least $400 in 2 of the prior 3 years. Caution. You may use this method no more than five times.16 Subtract line 15 from line 14 . . . . . . . . . . . . . . . . . . . . . . 16 17 Enter the smaller of: two-thirds (2/3) of gross nonfarm income4

(not less than zero) or the amount on line 16. Also include this amount on line 4b above . . . . . . . . . . . 17

1 From Sch. F, line 11, and Sch. K-1 (Form 1065), box 14, code B. 2 From Sch. F, line 36, and Sch. K-1 (Form 1065), box 14, code A—minus the

amount you would have entered on line 1b had you not used the optional method.

3 From Sch. C, line 31; Sch. C-EZ, line 3; Sch. K-1 (Form 1065), box 14, code A; and Sch. K-1 (Form 1065-B), box 9, code J1.

4 From Sch. C, line 7; Sch. C-EZ, line 1; Sch. K-1 (Form 1065), box 14, code C; and Sch. K-1 (Form 1065-B), box 9, code J2.

Schedule SE (Form 1040) 2010


Version A, Cycle 1

Form 982(Rev. February 2011)Department of the Treasury Internal Revenue Service

Reduction of Tax Attributes Due to Discharge of Indebtedness (and Section 1082 Basis Adjustment)

▶ Attach this form to your income tax return.

OMB No. 1545-0046


Name shown on return Identifying number

Part I General Information (see instructions)

1 Amount excluded is due to (check applicable box(es)):a Discharge of indebtedness in a title 11 case . . . . . . . . . . . . . . . . . . . . . . . .b Discharge of indebtedness to the extent insolvent (not in a title 11 case) . . . . . . . . . . . . . . .c Discharge of qualified farm indebtedness . . . . . . . . . . . . . . . . . . . . . . . . .d Discharge of qualified real property business indebtedness . . . . . . . . . . . . . . . . . . .e Discharge of qualified principal residence indebtedness . . . . . . . . . . . . . . . . . . . .

2 Total amount of discharged indebtedness excluded from gross income . . . . . . . . . 2 3 Do you elect to treat all real property described in section 1221(a)(1), relating to property held for sale to

customers in the ordinary course of a trade or business, as if it were depreciable property? . . . . . . Yes NoPart II Reduction of Tax Attributes. You must attach a description of any transactions resulting in the reduction in

basis under section 1017. See Regulations section 1.1017-1 for basis reduction ordering rules, and, if applicable, required partnership consent statements. (For additional information, see the instructions for Part II.)

Enter amount excluded from gross income:4 For a discharge of qualified real property business indebtedness, applied to reduce the basis of

depreciable real property . . . . . . . . . . . . . . . . . . . . . . . . 4 5 That you elect under section 108(b)(5) to apply first to reduce the basis (under section 1017) of

depreciable property . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6 Applied to reduce any net operating loss that occurred in the tax year of the discharge or carried

over to the tax year of the discharge . . . . . . . . . . . . . . . . . . . . . 6

7 Applied to reduce any general business credit carryover to or from the tax year of the discharge . 7 8 Applied to reduce any minimum tax credit as of the beginning of the tax year immediately after the

tax year of the discharge . . . . . . . . . . . . . . . . . . . . . . . . . 8 9 Applied to reduce any net capital loss for the tax year of the discharge including any capital loss

carryovers to the tax year of the discharge . . . . . . . . . . . . . . . . . . . 9 10a Applied to reduce the basis of nondepreciable and depreciable property if not reduced on line 5.

DO NOT use in the case of discharge of qualified farm indebtedness . . . . . . . . . . 10ab Applied to reduce the basis of your principal residence. Enter amount here ONLY if line 1e is

checked . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10b11 For a discharge of qualified farm indebtedness, applied to reduce the basis of:

a Depreciable property used or held for use in a trade or business, or for the production of income, if not reduced on line 5 . . . . . . . . . . . . . . . . . . . . . . . . . 11a

b Land used or held for use in a trade or business of farming . . . . . . . . . . . . . 11b

c Other property used or held for use in a trade or business, or for the production of income . . . 11c

12 Applied to reduce any passive activity loss and credit carryovers from the tax year of the discharge 12

13 Applied to reduce any foreign tax credit carryover to or from the tax year of the discharge . . . 13

Part III Consent of Corporation to Adjustment of Basis of Its Property Under Section 1082(a)(2)

Under section 1081(b), the corporation named above has excluded $ from its gross incomefor the tax year beginning , and ending .Under that section, the corporation consents to have the basis of its property adjusted in accordance with the regulations prescribed under section 1082(a)(2) in effect at the time of filing its income tax return for that year. The corporation is organized under the laws

of .(State of incorporation)

Note. You must attach a description of the transactions resulting in the nonrecognition of gain under section 1081.

For Paperwork Reduction Act Notice, see page 5 of this form. Cat. No. 17066E Form 982 (Rev. 2-2011)


Form 1116 Department of the Treasury Internal Revenue Service (99)

Foreign Tax Credit (Individual, Estate, or Trust)

▶ Attach to Form 1040, 1040NR, 1041, or 990-T. ▶ See separate instructions.

OMB No. 1545-0121


Name Identifying number as shown on page 1 of your tax return

Use a separate Form 1116 for each category of income listed below. See Categories of Income in the instructions. Check only one box on each Form 1116. Report all amounts in U.S. dollars except where specified in Part II below.

a Passive category income

b General category income

c Section 901(j) income

d Certain income re-sourced by treaty

e Lump-sum distributions

f Resident of (name of country) ▶Note: If you paid taxes to only one foreign country or U.S. possession, use column A in Part I and line A in Part II. If you paid taxes to more than one foreign country or U.S. possession, use a separate column and line for each country or possession.

Part I Taxable Income or Loss From Sources Outside the United States (for Category Checked Above) Foreign Country or U.S. Possession

A B C Total

(Add cols. A, B, and C.) g Enter the name of the foreign country or U.S. possession . . . . . . . . . . . ▶

1a Gross income from sources within country shownabove and of the type checked above (see instructions):

1ab Check if line 1a is compensation for personal

services as an employee, your total compensation from all sources is $250,000 or more, and you used an alternative basis to determine its source (see instructions) . . ▶

Deductions and losses (Caution: See instructions):

2

Expenses definitely related to the income on line1a (attach statement) . . . . . . . . .

3

Pro rata share of other deductions not definitely related:

a

Certain itemized deductions or standard deduction(see instructions) . . . . . . . . . . .

b Other deductions (attach statement) . . . . .c Add lines 3a and 3b . . . . . . . . . .d Gross foreign source income (see instructions) .e Gross income from all sources (see instructions) .f Divide line 3d by line 3e (see instructions) . . .g Multiply line 3c by line 3f . . . . . . . .

4 Pro rata share of interest expense (see instructions):

a

Home mortgage interest (use worksheet on page 14 of the instructions) . . . . . . . . .

b Other interest expense . . . . . . . . .5 Losses from foreign sources . . . . . . .6 Add lines 2, 3g, 4a, 4b, and 5 . . . . . . . 67 Subtract line 6 from line 1a. Enter the result here and on line 14, page 2 . . . . . . . . . . ▶ 7

Part II Foreign Taxes Paid or Accrued (see instructions)

Co

untr

y

Credit is claimed for taxes

(you must check one)

(h) Paid

(i) Accrued

(j) Date paid or accrued

Foreign taxes paid or accrued

In foreign currency

Taxes withheld at source on:

(k) Dividends (l) Rents

and royalties (m) Interest

(n) Other foreign taxes

paid or accrued

In U.S. dollars

Taxes withheld at source on:

(o) Dividends (p) Rents and royalties

(q) Interest

(r) Other foreign taxes

paid or accrued

(s) Total foreign taxes paid or

accrued (add cols. (o) through (r))

A B C

8 Add lines A through C, column (s). Enter the total here and on line 9, page 2 . . . . . . . . ▶ 8 For Paperwork Reduction Act Notice, see instructions. Cat. No. 11440U Form 1116 (2010)


Form 1116 (2010) Page 2 Part III Figuring the Credit

9

Enter the amount from line 8. These are your total foreign taxes paid or accrued for the category of income checked above Part I . . 9

10 Carryback or carryover (attach detailed computation) . . . . 10

11 Add lines 9 and 10 . . . . . . . . . . . . . . . 11

12 Reduction in foreign taxes (see instructions) 12

13

Subtract line 12 from line 11. This is the total amount of foreign taxes available for credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

14

Enter the amount from line 7. This is your taxable income or (loss) from sources outside the United States (before adjustments) for the category of income checked above Part I (see instructions) . . . . . . 14

15 Adjustments to line 14 (see instructions) . . . . . . . . 15

16

Combine the amounts on lines 14 and 15. This is your net foreign source taxable income. (If the result is zero or less, you have no foreign tax credit for the category of income you checked above Part I. Skip lines 17 through 21. However, if you are filing more than one Form 1116, you must complete line 19.) . . . . . . . 16

17

Individuals: Enter the amount from Form 1040, line 41, or Form 1040NR, line 39. Estates and trusts: Enter your taxable income without the deduction for your exemption . . . . . . . . 17

Caution: If you figured your tax using the lower rates on qualified dividends or capital gains, see instructions.

18 Divide line 16 by line 17. If line 16 is more than line 17, enter “1” . . . . . . . . . . . 18

19

Individuals: Enter the amount from Form 1040, line 44. If you are a nonresident alien, enter the amount from Form 1040NR, line 42. Estates and trusts: Enter the amount from Form 1041, Schedule G, line 1a, or the total of Form 990-T, lines 36 and 37 . . . . . . . . . . . 19

Caution: If you are completing line 19 for separate category e (lump-sum distributions), see instructions.

20 Multiply line 19 by line 18 (maximum amount of credit) . . . . . . . . . . . . . . 20

21

Enter the smaller of line 13 or line 20. If this is the only Form 1116 you are filing, skip lines 22 through 26 and enter this amount on line 27. Otherwise, complete the appropriate line in Part IV (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ 21

Part IV Summary of Credits From Separate Parts III (see instructions) 22 Credit for taxes on passive category income . . . . . . . 22 23 Credit for taxes on general category income . . . . . . . 23 24 Credit for taxes on certain income re-sourced by treaty . . . . 24 25 Credit for taxes on lump-sum distributions . . . . . . . . 25 26 Add lines 22 through 25 . . . . . . . . . . . . . . . . . . . . . . . 26 27 Enter the smaller of line 19 or line 26 . . . . . . . . . . . . . . . . . . . 27 28 Reduction of credit for international boycott operations. See instructions for line 12 . . . . . 28

29

Subtract line 28 from line 27. This is your foreign tax credit. Enter here and on Form 1040, line 47; Form 1040NR, line 45; Form 1041, Schedule G, line 2a; or Form 990-T, line 40a . . . . . . ▶ 29

Form 1116 (2010)



Employee Business Expenses ▶ See separate instructions.

▶ Attach to Form 1040 or Form 1040NR.

OMB No. 1545-0074

2010 Attachment Sequence No. 129

Your name Occupation in which you incurred expenses Social security number

Part I Employee Business Expenses and Reimbursements

Step 1 Enter Your Expenses Column A

Other Than Meals and Entertainment

Column B Meals and

Entertainment

1 Vehicle expense from line 22 or line 29. (Rural mail carriers: See instructions.) . . . . . . . . . . . . . . . . . . 1

2 Parking fees, tolls, and transportation, including train, bus, etc., that did not involve overnight travel or commuting to and from work . 2

3 Travel expense while away from home overnight, including lodging, airplane, car rental, etc. Do not include meals and entertainment . 3

4 Business expenses not included on lines 1 through 3. Do not include meals and entertainment . . . . . . . . . . . . . . 4

5 Meals and entertainment expenses (see instructions) . . . . . 5 6 Total expenses. In Column A, add lines 1 through 4 and enter the

result. In Column B, enter the amount from line 5 . . . . . . 6

Note: If you were not reimbursed for any expenses in Step 1, skip line 7 and enter the amount from line 6 on line 8.

Step 2 Enter Reimbursements Received From Your Employer for Expenses Listed in Step 1

7 Enter reimbursements received from your employer that were not reported to you in box 1 of Form W-2. Include any reimbursements reported under code “L” in box 12 of your Form W-2 (see instructions) . . . . . . . . . . . . . . . . . . . 7

Step 3 Figure Expenses To Deduct on Schedule A (Form 1040 or Form 1040NR)

8 Subtract line 7 from line 6. If zero or less, enter -0-. However, if line 7is greater than line 6 in Column A, report the excess as income onForm 1040, line 7 (or on Form 1040NR, line 8) . . . . . . . 8

Note: If both columns of line 8 are zero, you cannot deduct employee business expenses. Stop here and attach Form 2106 to your return.

9 In Column A, enter the amount from line 8. In Column B, multiply line8 by 50% (.50). (Employees subject to Department of Transportation(DOT) hours of service limits: Multiply meal expenses incurred whileaway from home on business by 80% (.80) instead of 50%. For details, see instructions.) . . . . . . . . . . . . . . 9

10 Add the amounts on line 9 of both columns and enter the total here. Also, enter the total on Schedule A (Form 1040), line 21 (or on Schedule A (Form 1040NR), line 9). (Armed Forces reservists, qualified performing artists, fee-basis state or local government officials, and individuals with disabilities: See the instructions for special rules on where to enter the total.) . . . . . ▶ 10

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11700N Form 2106 (2010)

Official Use Only


Form 2106 (2010) Page 2 Part II Vehicle Expenses

Section A—General Information (You must complete this section if you are claiming vehicle expenses.)

(a) Vehicle 1 (b) Vehicle 2

11 Enter the date the vehicle was placed in service . . . . . . . . . 11 / / / / 12 Total miles the vehicle was driven during 2010 . . . . . . . . . 12 miles miles 13 Business miles included on line 12 . . . . . . . . . . . . . 13 miles miles 14 Percent of business use. Divide line 13 by line 12 . . . . . . . . . 14 % % 15 Average daily roundtrip commuting distance . . . . . . . . . . 15 miles miles 16 Commuting miles included on line 12 . . . . . . . . . . . . 16 miles miles 17 Other miles. Add lines 13 and 16 and subtract the total from line 12 . . 17 miles miles 18 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . Yes No19 Do you (or your spouse) have another vehicle available for personal use? . . . . . . . . . . . Yes No20 Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . Yes No21 If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Section B—Standard Mileage Rate (See the instructions for Part II to find out whether to complete this section or Section C.) 22 Multiply line 13 by 50¢ (.50). Enter the result here and on line 1 . . . . . . . . . . . 22

Section C—Actual Expenses (a) Vehicle 1 (b) Vehicle 2 23 Gasoline, oil, repairs, vehicle

insurance, etc. . . . . . . 23 24a Vehicle rentals . . . . . . 24a

b Inclusion amount (see instructions) . 24b c Subtract line 24b from line 24a . 24c

25 Value of employer-provided vehicle (applies only if 100% of annual lease value was included on Form W-2—see instructions) . . . . 25

26 Add lines 23, 24c, and 25. . . 26 27 Multiply line 26 by the percentage

on line 14 . . . . . . . . 27 28 Depreciation (see instructions) . 28 29 Add lines 27 and 28. Enter total

here and on line 1 . . . . . 29 Section D—Depreciation of Vehicles (Use this section only if you owned the vehicle and are completing Section C for the vehicle.) (a) Vehicle 1 (b) Vehicle 2

30 Enter cost or other basis (see instructions) . . . . . . . 30

31 Enter section 179 deduction and special allowance (see instructions) 31

32 Multiply line 30 by line 14 (see instructions if you claimed the section 179 deduction or special allowance). . . . . . . . 32

33 Enter depreciation method and percentage (see instructions) . 33

34 Multiply line 32 by the percentage on line 33 (see instructions) . . 34

35 Add lines 31 and 34 . . . . 35 36 Enter the applicable limit explained

in the line 36 instructions . . . 36 37 Multiply line 36 by the percentage

on line 14 . . . . . . . . 37

38 Enter the smaller of line 35 or line 37. If you skipped lines 36 and 37, enter the amount from line 35. Also enter this amount on line 28 above . . . . . . . . .

38

Form 2106 (2010)

Official Use Only


Form 2106-EZDepartment of the Treasury Internal Revenue Service (99)

Unreimbursed Employee Business Expenses


OMB No. 1545-0074


Your name Occupation in which you incurred expenses Social security number

You Can Use This Form Only if All of the Following Apply.

• You are an employee deducting ordinary and necessary expenses attributable to your job. An ordinary expense is one that is common and accepted in your field of trade, business, or profession. A necessary expense is one that is helpful and appropriate for your business. An expense does not have to be required to be considered necessary.

• You do not get reimbursed by your employer for any expenses (amounts your employer included in box 1 of your Form W-2 are not considered reimbursements for this purpose).• If you are claiming vehicle expense, you are using the standard mileage rate for 2010.Caution: You can use the standard mileage rate for 2010 only if: (a) you owned the vehicle and used the standard mileage rate for the first year you placed the vehicle in service, or (b) you leased the vehicle and used the standard mileage rate for the portion of the lease period after 1997.

Part I Figure Your Expenses

1 Vehicle expense using the standard mileage rate. Complete Part II and multiply line 8a by 50¢ (.50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Parking fees, tolls, and transportation, including train, bus, etc., that did not involve overnight travel or commuting to and from work . . . . . . . . . . . . . . . . . . . 2

3 Travel expense while away from home overnight, including lodging, airplane, car rental, etc. Do not include meals and entertainment . . . . . . . . . . . . . . . . . . . . 3

4 Business expenses not included on lines 1 through 3. Do not include meals and entertainment . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Meals and entertainment expenses: $ × 50% (.50). (Employees subject toDepartment of Transportation (DOT) hours of service limits: Multiply meal expenses incurred while away from home on business by 80% (.80) instead of 50%. For details, see instructions.) 5

6 Total expenses. Add lines 1 through 5. Enter here and on Schedule A (Form 1040), line 21 (or on Schedule A (Form 1040NR), line 9). (Armed Forces reservists, fee-basis state or local government officials, qualified performing artists, and individuals with disabilities: See theinstructions for special rules on where to enter this amount.) . . . . . . . . . . . . 6

Part II Information on Your Vehicle. Complete this part only if you are claiming vehicle expense on line 1.

7 When did you place your vehicle in service for business use? (month, day, year) ▶ / /


a Business b Commuting (see instructions) c Other

9 Was your vehicle available for personal use during off-duty hours? . . . . . . . . . . . . . . Yes No

10 Do you (or your spouse) have another vehicle available for personal use? . . . . . . . . . . . . Yes No

11a Do you have evidence to support your deduction? . . . . . . . . . . . . . . . . . . . Yes No

b If “Yes,” is the evidence written? . . . . . . . . . . . . . . . . . . . . . . . . . Yes NoFor Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 20604Q Form 2106-EZ (2010)


VOID CORRECTED (99)

OMB No. 1545-0145

2010

Form 2439

Notice to Shareholder of Undistributed Long-Term Capital Gains

For calendar year 2010, or other tax year of the regulated investment company (RIC) or the

real estate investment trust (REIT)

beginning , 2010, and

ending , 20

Copy A Attach to

Form 1120-RIC or Form 1120-REIT

For Instructions and Paperwork Reduction Act

Notice, see back of Copies A and D.

Cat. No. 11858E Department of the Treasury - Internal Revenue Service

Name, address, and ZIP code of RIC or REIT

Identification number of RIC or REIT

Shareholder’s identifying number

Shareholder’s name, address, and ZIP code

1a Total undistributed long-term capital gains

1b Unrecaptured section 1250 gain

1c Section 1202 gain 1d Collectibles (28%) gain

2 Tax paid by the RIC or REIT on the box 1a gains

Form 2439


Form 2441Department of the Treasury Internal Revenue Service (99)

Child and Dependent Care Expenses

▶ Attach to Form 1040, Form 1040A, or Form 1040NR.

▶ See separate instructions.

1040A . . . . . . . . . . 1040

2441

◀. . . . . . . . . .

1040NR

OMB No. 1545-0074



Part I Persons or Organizations Who Provided the Care—You must complete this part. (If you have more than two care providers, see the instructions.)

1 (a) Care provider’s name

(b) Address (number, street, apt. no., city, state, and ZIP code)

(c) Identifying number (SSN or EIN)

(d) Amount paid (see instructions)

Did you receive dependent care benefits?

No ▶ Complete only Part II below.

Yes ▶ Complete Part III on the back next.Caution. If the care was provided in your home, you may owe employment taxes. If you do, you cannot file Form 1040A. For details, see the instructions for Form 1040, line 59, or Form 1040NR, line 58.

Part II Credit for Child and Dependent Care Expenses2 Information about your qualifying person(s). If you have more than two qualifying persons, see the instructions.

(a) Qualifying person’s name

First Last

(b) Qualifying person’s social security number

(c) Qualified expenses you incurred and paid in 2010 for the

person listed in column (a)

3 Add the amounts in column (c) of line 2. Do not enter more than $3,000 for one qualifying person or $6,000 for two or more persons. If you completed Part III, enter the amount from line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Enter your earned income. See instructions . . . . . . . . . . . . . . . 4 5 If married filing jointly, enter your spouse’s earned income (if your spouse was a student

or was disabled, see the instructions); all others, enter the amount from line 4 . . . . 5 6 Enter the smallest of line 3, 4, or 5 . . . . . . . . . . . . . . . . . . 6 7 Enter the amount from Form 1040, line 38; Form

1040A, line 22; or Form 1040NR, line 37. . . . . 7 8 Enter on line 8 the decimal amount shown below that applies to the amount on line 7

If line 7 is:

OverBut not over

Decimal amount is

$0—15,000 .35

15,000—17,000 .34

17,000—19,000 .33

19,000—21,000 .32

21,000—23,000 .31

23,000—25,000 .30

25,000—27,000 .29

27,000—29,000 .28

If line 7 is:

OverBut not over

Decimal amount is

$29,000—31,000 .27

31,000—33,000 .26

33,000—35,000 .25

35,000—37,000 .24

37,000—39,000 .23

39,000—41,000 .22

41,000—43,000 .21

43,000—No limit .20

8

9 Multiply line 6 by the decimal amount on line 8. If you paid 2009 expenses in 2010, see the instructions . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Tax liability limit. Enter the amount from the Credit Limit Worksheet in the instructions. . . . . . . 10

11 Credit for child and dependent care expenses. Enter the smaller of line 9 or line 10 here and on Form 1040, line 48; Form 1040A, line 29; or Form 1040NR, line 46 . . . . 11

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11862M Form 2441 (2010)

Number of qualified persons

Child-Care-Cr-Depd-Dob2

Prior Yr Expenses

Child-Care-Cr-Depd-Dob1

Current Yr AGI Limit


Form 2441 (2010) Page 2Part III Dependent Care Benefits12 Enter the total amount of dependent care benefits you received in 2010. Amounts you

received as an employee should be shown in box 10 of your Form(s) W-2. Do not includeamounts reported as wages in box 1 of Form(s) W-2. If you were self-employed or a partner, include amounts you received under a dependent care assistance program fromyour sole proprietorship or partnership . . . . . . . . . . . . . . . . . . 12

13 Enter the amount, if any, you carried over from 2009 and used in 2010 during the grace period. See instructions . . . . . . . . . . . . . . . . . . . . . . . 13

14 Enter the amount, if any, you forfeited or carried forward to 2011. See instructions . . . 14 ( )15 Combine lines 12 through 14. See instructions . . . . . . . . . . . . . . . 15 16 Enter the total amount of qualified expenses incurred

in 2010 for the care of the qualifying person(s) . . . 16 17 Enter the smaller of line 15 or 16 . . . . . . . . 17 18 Enter your earned income. See instructions . . . . 18 19 Enter the amount shown below that applies

to you.

• If married filing jointly, enter your spouse’s earned income (if your spouse was a student or was disabled, see the instructions for line 5).

• If married filing separately, see instructions.

• All others, enter the amount from line 18.

} . . . 19

20 Enter the smallest of line 17, 18, or 19 . . . . . . 20 21 Enter $5,000 ($2,500 if married filing separately and

you were required to enter your spouse’s earned income on line 19) . . . . . . . . . . . . . 21

22 Is any amount on line 12 from your sole proprietorship or partnership? (Form 1040A filers go to line 25.)

No. Enter -0-.Yes. Enter the amount here . . . . . . . . . . . . . . . . . . . . 22

23 Subtract line 22 from line 15 . . . . . . . . . 23 24 Deductible benefits. Enter the smallest of line 20, 21, or 22. Also, include this amount on

the appropriate line(s) of your return. See instructions . . . . . . . . . . . . . 24

25 Excluded benefits. Form 1040 and 1040NR filers: If you checked "No" on line 22, enter the smaller of line 20 or 21. Otherwise, subtract line 24 from the smaller of line 20 or line21. If zero or less, enter -0-. Form 1040A filers: Enter the smaller of line 20 or line 21 . . 25

26 Taxable benefits. Form 1040 and 1040NR filers: Subtract line 25 from line 23. If zero or less, enter -0-. Also, include this amount on Form 1040, line 7; or Form 1040NR, line 8. Onthe dotted line next to Form 1040, line 7; or Form 1040NR, line 8, enter “DCB.”Form 1040A filers: Subtract line 25 from line 15. Also, include this amount on Form 1040A, line 7. In the space to the left of line 7, enter “DCB” . . . . . . . . . . . . . . 26

To claim the child and dependent care credit, complete lines 27 through 31 below.

27 Enter $3,000 ($6,000 if two or more qualifying persons) . . . . . . . . . . . . 27 28 Form 1040 and 1040NR filers: Add lines 24 and 25. Form 1040A filers: Enter the amount

from line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 29 Subtract line 28 from line 27. If zero or less, stop. You cannot take the credit.

Exception. If you paid 2009 expenses in 2010, see the instructions for line 9 . . . . . 29 30 Complete line 2 on the front of this form. Do not include in column (c) any benefits shown

on line 28 above. Then, add the amounts in column (c) and enter the total here. . . . . 30 31 Enter the smaller of line 29 or 30. Also, enter this amount on line 3 on the front of this form

and complete lines 4 through 11 . . . . . . . . . . . . . . . . . . . . 31 Form 2441 (2010)


Form 2555 Department of the Treasury Internal Revenue Service

Foreign Earned Income ▶ See separate instructions. ▶ Attach to Form 1040.

OMB No. 1545-0074


For Use by U.S. Citizens and Resident Aliens Only Name shown on Form 1040 Your social security number

Part I General Information

1 Your foreign address (including country) 2 Your occupation

3 Employer’s name ▶

4 a Employer’s U.S. address ▶

b Employer’s foreign address ▶

5 Employer is (check any that apply):

▲

a A foreign entity b A U.S. company c Self d A foreign affiliate of a U.S. company e Other (specify) ▶

6 a If, after 1981, you filed Form 2555 or Form 2555-EZ, enter the last year you filed the form. ▶

b If you did not file Form 2555 or 2555-EZ after 1981 to claim either of the exclusions, check here ▶ and go to line 7. c Have you ever revoked either of the exclusions? . . . . . . . . . . . . . . . . . . . . Yes Nod If you answered “Yes,” enter the type of exclusion and the tax year for which the revocation was effective. ▶

7 Of what country are you a citizen/national? ▶

8 a Did you maintain a separate foreign residence for your family because of adverse living conditions at your tax home? See Second foreign household on page 3 of the instructions . . . . . . . . . . . Yes No

b If “Yes,” enter city and country of the separate foreign residence. Also, enter the number of days during your tax year that you maintained a second household at that address. ▶

9 List your tax home(s) during your tax year and date(s) established. ▶

Next, complete either Part II or Part III. If an item does not apply, enter “NA.” If you do not give the information asked for, any exclusion or deduction you claim may be disallowed.

Part II Taxpayers Qualifying Under Bona Fide Residence Test (see page 2 of the instructions)

10 Date bona fide residence began ▶ , and ended ▶

11 Kind of living quarters in foreign country ▶ a Purchased house b Rented house or apartment c Rented room d Quarters furnished by employer

12a Did any of your family live with you abroad during any part of the tax year? . . . . . . . . . . . Yes Nob If “Yes,” who and for what period? ▶

13a Have you submitted a statement to the authorities of the foreign country where you claim bona fide residence that you are not a resident of that country? See instructions . . . . . . . . . . . . Yes No

b Are you required to pay income tax to the country where you claim bona fide residence? See instructions . Yes NoIf you answered “Yes” to 13a and “No” to 13b, you do not qualify as a bona fide resident. Do not complete the rest of this part.

14 If you were present in the United States or its possessions during the tax year, complete columns (a)–(d) below. Do not include the income from column (d) in Part IV, but report it on Form 1040.

(a) Date arrived in U.S.

(b) Date left U.S.

(c) Number of days in U.S. on business

(d) Income earned in U.S. on business

(attach computation)

(a) Date arrived in U.S.

(b) Date left U.S.

(c) Number of days in U.S. on

business

(d) Income earned in U.S. on business

(attach computation)

15a List any contractual terms or other conditions relating to the length of your employment abroad. ▶

b Enter the type of visa under which you entered the foreign country. ▶ c Did your visa limit the length of your stay or employment in a foreign country? If “Yes,” attach explanation . Yes Nod Did you maintain a home in the United States while living abroad? . . . . . . . . . . . . . . Yes Noe If “Yes,” enter address of your home, whether it was rented, the names of the occupants, and their relationship

to you. ▶

For Paperwork Reduction Act Notice, see the Form 1040 instructions. Cat. No. 11900P Form 2555 (2010)

country code for post of duty


Form 2555 (2010) Page 2

Part III Taxpayers Qualifying Under Physical Presence Test (see page 2 of the instructions)

16 The physical presence test is based on the 12-month period from ▶ through ▶ 17 Enter your principal country of employment during your tax year. ▶

18 If you traveled abroad during the 12-month period entered on line 16, complete columns (a)–(f) below. Exclude travel between foreign countries that did not involve travel on or over international waters, or in or over the United States, for 24 hours or more. If you have no travel to report during the period, enter “Physically present in a foreign country or countries for the entire 12-month period.” Do not include the income from column (f) below in Part IV, but report it on Form 1040.

(a) Name of country (including U.S.)

(b) Date arrived (c) Date left (d) Full days present in country

(e) Number of days in U.S. on business

(f) Income earned in U.S. on business (attach

computation)

Part IV All Taxpayers

Note: Enter on lines 19 through 23 all income, including noncash income, you earned and actually or constructively received during your 2010 tax year for services you performed in a foreign country. If any of the foreign earned income received this tax year was earned in a prior tax year, or will be earned in a later tax year (such as a bonus), see the instructions. Do not include income from line 14, column (d), or line 18, column (f). Report amounts in U.S. dollars, using the exchange rates in effect when you actually or constructively received the income.

If you are a cash basis taxpayer, report on Form 1040 all income you received in 2010, no matter when you performed the service.

2010 Foreign Earned Income Amount (in U.S. dollars)

19 Total wages, salaries, bonuses, commissions, etc. . . . . . . . . . . . . . . . 19 20 Allowable share of income for personal services performed (see instructions):

a In a business (including farming) or profession . . . . . . . . . . . . . . . . . 20a b In a partnership. List partnership’s name and address and type of income. ▶

20b 21 Noncash income (market value of property or facilities furnished by employer—attach statement

showing how it was determined): a Home (lodging) . . . . . . . . . . . . . . . . . . . . . . . . . . . 21a

b Meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21b

c Car . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21c d Other property or facilities. List type and amount. ▶

21d 22 Allowances, reimbursements, or expenses paid on your behalf for services you performed:

a Cost of living and overseas differential . . . . . . . . . 22a b Family . . . . . . . . . . . . . . . . . . . . 22b c Education . . . . . . . . . . . . . . . . . . . 22c d Home leave . . . . . . . . . . . . . . . . . . 22d e Quarters . . . . . . . . . . . . . . . . . . . 22e f For any other purpose. List type and amount. ▶

22f

g Add lines 22a through 22f . . . . . . . . . . . . . . . . . . . . . . . 22g 23 Other foreign earned income. List type and amount. ▶

23

24 Add lines 19 through 21d, line 22g, and line 23 . . . . . . . . . . . . . . . . 24

25 Total amount of meals and lodging included on line 24 that is excludable (see instructions) 25 26 Subtract line 25 from line 24. Enter the result here and on line 27 on page 3. This is your 2010

foreign earned income . . . . . . . . . . . . . . . . . . . . . . . ▶ 26 Form 2555 (2010)


Form 2555 (2010) Page 3

Part V All Taxpayers

27 Enter the amount from line 26 . . . . . . . . . . . . . . . . . . . . . . 27 Are you claiming the housing exclusion or housing deduction?

Yes. Complete Part VI. No. Go to Part VII.

Part VI Taxpayers Claiming the Housing Exclusion and/or Deduction

28 Qualified housing expenses for the tax year (see instructions) . . . . . . . . . . . . 28 29a Enter location where housing expenses incurred (see instructions) ▶

b Enter limit on housing expenses (see instructions) . . . . . . . . . . . . . . . 29b 30 Enter the smaller of line 28 or line 29b . . . . . . . . . . . . . . . . . . . 30 31 Number of days in your qualifying period that fall within your 2010 tax

year (see instructions) . . . . . . . . . . . . . . . . 31 days 32 Multiply $40.11 by the number of days on line 31. If 365 is entered on line 31, enter $14,640.00 here 32 33 Subtract line 32 from line 30. If the result is zero or less, do not complete the rest of this part or

any of Part IX . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 34 Enter employer-provided amounts (see instructions) . . . . . . 34 35 Divide line 34 by line 27. Enter the result as a decimal (rounded to at least three places), but do

not enter more than “1.000” . . . . . . . . . . . . . . . . . . . . . . . 35 36 Housing exclusion. Multiply line 33 by line 35. Enter the result but do not enter more than the

amount on line 34. Also, complete Part VIII . . . . . . . . . . . . . . . . . ▶ 36 Note: The housing deduction is figured in Part IX. If you choose to claim the foreign earned income exclusion, complete Parts VII and VIII before Part IX.

Part VII Taxpayers Claiming the Foreign Earned Income Exclusion

37 Maximum foreign earned income exclusion . . . . . . . . . . . . . . . . . . . . . 37 $91,500 0038 • If you completed Part VI, enter the number from line 31.

• All others, enter the number of days in your qualifying period that fall within your 2010 tax year (see the instructions for line 31).

} 38 days

39 • If line 38 and the number of days in your 2010 tax year (usually 365) are the same, enter “1.000.”

• Otherwise, divide line 38 by the number of days in your 2010 tax year and enter the result as a decimal (rounded to at least three places).

} 39

40 Multiply line 37 by line 39 . . . . . . . . . . . . . . . . . . . . . . . 40 41 Subtract line 36 from line 27 . . . . . . . . . . . . . . . . . . . . . . 41 42 Foreign earned income exclusion. Enter the smaller of line 40 or line 41. Also, complete Part VIII ▶ 42

Part VIII Taxpayers Claiming the Housing Exclusion, Foreign Earned Income Exclusion, or Both

43 Add lines 36 and 42 . . . . . . . . . . . . . . . . . . . . . . . . . 43 44 Deductions allowed in figuring your adjusted gross income (Form 1040, line 37) that are allocable

to the excluded income. See instructions and attach computation . . . . . . . . . . 44 45 Subtract line 44 from line 43. Enter the result here and in parentheses on Form 1040, line 21.

Next to the amount enter “Form 2555.” On Form 1040, subtract this amount from your income to arrive at total income on Form 1040, line 22 . . . . . . . . . . . . . . . . 45

Part IX Taxpayers Claiming the Housing Deduction— Complete this part only if (a) line 33 is more than line 36 and (b) line 27 is more than line 43.

46 Subtract line 36 from line 33 . . . . . . . . . . . . . . . . . . . . . . 46 47 Subtract line 43 from line 27 . . . . . . . . . . . . . . . . . . . . . . 47 48 Enter the smaller of line 46 or line 47 . . . . . . . . . . . . . . . . . . . 48

Note: If line 47 is more than line 48 and you could not deduct all of your 2009 housing deduction because of the 2009 limit, use the worksheet on page 4 of the instructions to figure the amount to enter on line 49. Otherwise, go to line 50.

49 Housing deduction carryover from 2009 (from worksheet on page 4 of the instructions) . . . 49 50 Housing deduction. Add lines 48 and 49. Enter the total here and on Form 1040 to the left of

line 36. Next to the amount on Form 1040, enter “Form 2555.” Add it to the total adjustments reported on that line . . . . . . . . . . . . . . . . . . . . . . . . ▶ 50

Form 2555 (2010)


Form 2555-EZDepartment of the Treasury Internal Revenue Service (99)

Foreign Earned Income Exclusion ▶ See separate instructions. ▶ Attach to Form 1040.

OMB No. 1545-0074


Name shown on Form 1040 Your social security number

You May Use This Form

If You:

• Are a U.S. citizen or a resident alien. • Earned wages/salaries in a foreign country. • Had total foreign earned income

of $91,500 or less.• Are filing a calendar year return that covers

a 12-month period.

And You:

• Do not have self-employment income.

• Do not have business/moving expenses.

• Do not claim the foreign housing exclusion or deduction.

Tests To See If You Can Take the Foreign Earned Income Exclusion Part I

1 Bona Fide Residence Test a Were you a bona fide resident of a foreign country or countries for a period that includes an entire tax year

(see page 2 of the instructions)? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No• If you answered “Yes,” you meet this test. Fill in line 1b and then go to line 3. • If you answered “No,” you do not meet this test. Go to line 2 to see if you meet the Physical Presence Test.

b Enter the date your bona fide residence began ▶ , and ended (see instructions) ▶ .

2 Physical Presence Test a Were you physically present in a foreign country or countries for at least 330 full days during—

{ 2010 or any other period of 12 months in a row starting or ending in 2010? } . . . . . . . . . . . . . Yes No

• If you answered “Yes,” you meet this test. Fill in line 2b and then go to line 3. • If you answered “No,” you do not meet this test. You cannot take the exclusion unless you meet the

Bona Fide Residence Test above. b The physical presence test is based on the 12-month period from ▶ through ▶

3 Tax Home Test. Was your tax home in a foreign country or countries throughout your period of bona fide residence or physical presence, whichever applies? . . . . . . . . . . . . . . . . . . . Yes No• If you answered “Yes,” you can take the exclusion. Complete Part II below and then go to page 2. • If you answered “No,” you cannot take the exclusion. Do not file this form.

.

General Information Part II

4 Your foreign address (including country) 5 Your occupation

6 Employer’s name 7 Employer’s U.S. address (including ZIP code) 8 Employer’s foreign address

9 Employer is (check any that apply):

a A U.S. business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b A foreign business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Other (specify) ▶

10 a If you filed Form 2555 or 2555-EZ after 1981, enter the last year you filed the form. ▶

b If you did not file Form 2555 or 2555-EZ after 1981, check here ▶ and go to line 11a now.

c Have you ever revoked the foreign earned income exclusion? . . . . . . . . . . . . . . . Yes No

d If you answered “Yes,” enter the tax year for which the revocation was effective. ▶

11a List your tax home(s) during 2010 and date(s) established. ▶

b Of what country are you a citizen/national? ▶

For Paperwork Reduction Act Notice, see the Form 1040 instructions. Cat. No. 13272W Form 2555-EZ (2010)

COUNTRY CODE FOR POST OF DUTY


Form 2555-EZ (2010) Page 2

Days Present in the United States— Complete this part if you were in the United States or its possessions during 2010.

Part III

12 (a) Date arrived in U.S. (b) Date left U.S. (c) Number of days in U.S. on business

(d) Income earned in U.S. on business (attach computation)

Figure Your Foreign Earned Income Exclusion Part IV

13 Maximum foreign earned income exclusion . . . . . . . . . . . . . . . . . . 13 $91,500 00

14 Enter the number of days in your qualifying period that fall within 2010 . 14 days

15 Did you enter 365 on line 14? Yes. Enter “1.000.”

No. Divide line 14 by 365 and enter the result as a decimal (rounded to at least three places).

} . . . . . . . . . . . . . 15

16 Multiply line 13 by line 15 . . . . . . . . . . . . . . . . . . . . . . . . 16

17 Enter, in U.S. dollars, the total foreign earned income you earned and received in 2010 (see instructions). Be sure to include this amount on Form 1040, line 7 . . . . . . . . . . . 17

18 Foreign earned income exclusion. Enter the smaller of line 16 or line 17 here and in parentheses on Form 1040, line 21. Next to the amount enter “2555-EZ.” On Form 1040, subtract this amount from your income to arrive at total income on Form 1040, line 22 . . . . . . . . . . . ▶ 18

Form 2555-EZ (2010)


Version A, Cycle 2


Investment Credit

▶ Attach to your tax return. See instructions.

OMB No. 1545-0155


Name(s) shown on return Identifying number

Part I Information Regarding the Election To Treat the Lessee as the Purchaser of Investment Credit PropertyIf you are claiming the investment credit as a lessee based on a section 48(d) (as in effect on November 4, 1990) election, provide the following information. If you acquired more than one property as a lessee, attach a statement showing the information below.

1 Name of lessor2 Address of lessor3 Description of property4 Amount for which you were treated as having acquired the property . . . . . . . . . . ▶ $

Part II Qualifying Advanced Coal Project Credit, Qualifying Gasification Project Credit, Qualifying Advanced Energy Project Credit, and Qualifying Therapeutic Discovery Project Credit

5 Qualifying advanced coal project credit (see instructions):a Qualified investment in integrated gasification combined cycle property

placed in service during the tax year for projects described in section 48A(d)(3)(B)(i) . . . . . . . $ × 20% (.20) 5a

b Qualified investment in advanced coal-based generation technology property placed in service during the tax year for projects described insection 48A(d)(3)(B)(ii) . . . . . $ × 15% (.15) 5b

c Qualified investment in advanced coal-based generation technology property placed in service during the tax year for projects described insection 48A(d)(3)(B)(iii) . . . . . $ × 30% (.30) 5c

d Total. Add lines 5a, 5b, and 5c . . . . . . . . . . . . . . . . . . . . . . . 5d6 Qualifying gasification project credit (see instructions):

a Qualified investment in qualified gasification property placed in service during the tax year for which credits were allocated or reallocated after October 3, 2008, and that includes equipment that separates andsequesters at least 75% of the project’s carbon dioxide emissions . . . . . . . . . $ × 30% (.30) 6a

b Qualified investment in property other than in a above placed in service during the tax year . . . . . . $ × 20% (.20) 6b

c Total. Add lines 6a and 6b . . . . . . . . . . . . . . . . . . . . . . . . 6c7 Qualifying advanced energy project credit (see instructions):

Qualified investment in advanced energy project property placed in service during the tax year . . . . . . . . . . . . $ × 30% (.30) 7

8 Qualifying therapeutic discovery project credit (see instructions):Qualified investment in a qualifying therapeutic discovery project $ × 50% (.50) 8

9 Enter the applicable unused investment credit from cooperatives (see instructions) . . . . . 910 Add lines 5d, 6c, 7, 8, and 9. Report this amount on Form 3800, line 1a . . . . . . . . . 10Part III Rehabilitation Credit and Energy Credit11 Rehabilitation credit (see instructions for requirements that must be met):

a Check this box if you are electing under section 47(d)(5) to take your qualified rehabilitation expenditures into account for the tax year in which paid (or, for self-rehabilitated property, when capitalized). See instructions. Note. This election applies to the current tax year and to all later tax years. You may not revoke this election without IRS consent . . . . . . . . . . . ▶

b Enter the dates on which the 24- or 60-month measuring period beginsand ends

c Enter the adjusted basis of the building as of the beginning date above (or the first day of your holding period, if later) . . . . . . . . . $

d Enter the amount of the qualified rehabilitation expenditures incurred, or treated as incurred, during the period on line 11b above . . . . . $Enter the amount of qualified rehabilitation expenditures and multiply by the percentage shown:

e Pre-1936 buildings located in the Gulf Opportunity Zone . $ × 13% (.13) 11ef Pre-1936 buildings affected by a Midwestern disaster . . $ × 13% (.13) 11fg Other pre-1936 buildings . . . . . . . . . . . . $ × 10% (.10) 11gh Certified historic structures located in the Gulf Opportunity Zone $ × 26% (.26) 11h

For Paperwork Reduction Act Notice, see instructions. Cat. No. 12276E Form 3468 (2010)


Version A, Cycle 2

Form 3468 (2010) Page 2 Part III Rehabilitation Credit and Energy Credit (continued)

i Certified historic structures affected by a Midwestern disaster $ × 26% (.26) 11i

j Other certified historic structures . . . . . . . . . $ × 20% (.20) 11j

For properties identified on lines 11h, 11i, or 11j, complete lines 11k and 11l.k Enter the assigned NPS project number or the pass-through entity’s employer identification

number (see instructions) . . . . . . . . . . . . . . .

l Enter the date that the NPS approved the Request for Certification of Completed Work (see instructions) . . . . . . . . . . . . . . . . . . . .

m Rehabilitation credit from an electing large partnership (Schedule K-1 (Form 1065-B), box 9) . . 11m

12 Energy credit:a Basis of property using geothermal energy or solar energy (acquired before January 1, 2006, and

the basis attributable to construction, reconstruction, or erection by the taxpayer before January 1, 2006) placed in service during the tax year (see instructions) . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . $ × 10% (.10) 12a

b Basis of property using solar illumination or solar energy placed in service during the tax year that was acquired after December 31, 2005, and the basis attributable to construction, reconstruction, or erection by the taxpayer after December 31, 2005 (see instructions) . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . $ × 30% (.30) 12b

Qualified fuel cell property (see instructions):c Basis of property placed in service during the tax year that was acquired after December 31, 2005,

and before October 4, 2008, and the basis attributable to construction, reconstruction, or erectionby the taxpayer after December 31, 2005, and before October 4, 2008 . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . $ × 30% (.30) 12c

d Applicable kilowatt capacity of property on line 12c (see instructions) ▶ × $1,000 12d

e Enter the lesser of line 12c or line 12d . . . . . . . . . . . . . . . . . . . . 12e

f Basis of property placed in service during the tax year that was acquired after October 3, 2008, and the basis attributable to construction, reconstruction, or erection by the taxpayer after October 3, 2008 . . . . . . . . . . . . . . . $ × 30% (.30) 12f

g Applicable kilowatt capacity of property on line 12f (see instructions) ▶ × $3,000 12g

h Enter the lesser of line 12f or line 12g . . . . . . . . . . . . . . . . . . . . 12h

iQualified microturbine property (see instructions):Basis of property placed in service during the tax year that was acquired after December 31, 2005, and the basis attributable to construction, reconstruction, or erection by the taxpayer after December 31, 2005 . . . . . . . . . . . . . . $ × 10% (.10) 12i

j Kilowatt capacity of property on line 12i . . . . . . . . . . ▶ × $200 12j

k Enter the lesser of line 12i or line 12j . . . . . . . . . . . . . . . . . . . . . 12kForm 3468 (2010)


Version A, Cycle 2


Combined heat and power system property (see instructions):Caution. You cannot claim this credit if the electrical capacity of the property is more than 50 megawatts or 67,000 horsepower.

l Basis of property placed in service during the tax year that was acquired after October 3, 2008, and the basis attributable to construction, reconstruction, or erection by the taxpayer after October 3, 2008 . . . . . . . . . . . . . . . . $ × 10% (.10) 12l

m If the electrical capacity of the property is measured in:• Megawatts, divide 15 by the megawatt capacity. Enter 1.0 if the capacity is 15 megawatts or less.• Horsepower, divide 20,000 by the horsepower. Enter 1.0 if the capacity is 20,000 horsepower or less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12m .

n Multiply line 12l by line 12m . . . . . . . . . . . . . . . . . . . . . . . . 12n

Qualified small wind energy property (see instructions):o Basis of property placed in service during the tax year that was acquired after October 3, 2008,

and before January 1, 2009, and the basis attributable to the construction, reconstruction, or erection by the taxpayer after October 3, 2008, and before January 1, 2009 . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . $ × 30% (.30) 12o

p Enter the smaller of line 12o or $4,000 . . . . . . . . . . . . . . . . . . . . 12p

q Basis of property placed in service during the tax year that was acquired after December 31, 2008, and the basis attributable to construction, reconstruction, or erection by the taxpayer after December 31, 2008 . . . . . . . . . . . . . . $ × 30% (.30) 12q

Geothermal heat pump systems (see instructions):r Basis of property placed in service during the tax year that was acquired after October 3, 2008,

and the basis attributable to construction, reconstruction, or erection by the taxpayer after October 3, 2008 . . . . . . . . . . . . . . $ × 10% (.10) 12r

Qualified investment credit facility property (see instructions):s Basis of property placed in service during the tax year . . . $ × 30% (.30) 12s

13 Enter the applicable unused investment credit from cooperatives (see instructions) . . . . . 13

14 Add lines 11e through 11j, 11m, 12a, 12b, 12e, 12h, 12k, 12n, 12p, 12q, 12r, 12s, and 13 . . . 14

15 Rehabilitation and energy credits included on line 14 from passive activities . . . . . . . . 15

16 Subtract line 15 from line 14 . . . . . . . . . . . . . . . . . . . . . . . 16

17 Rehabilitation and energy credits allowed for 2010 from a passive activity . . . . . . . . 17

18 Carryforward of the rehabilitation credit that originated after 2007 and the energy credit that originated in a tax year that began after October 3, 2008 (see instructions) . . . . . . . . 18

19 Carryback of rehabilitation and energy credits from 2011 . . . . . . . . . . . . . . 19

20 Add lines 16 through 19. Report this amount on Form 3800, line 29a . . . . . . . . . . 20Form 3468 (2010)



General Business Credit▶ See separate instructions. ▶ Attach to your tax return.

OMB No. 1545-0895



Part I Current Year Credit

Important: You may not be required to complete and file a separate credit form (shown in parentheses below) to claim the credit. For details, see the instructions.

1a Investment credit (Form 3468, Part II only) (attach Form 3468) . . . . . . . . . . . 1a b Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . 1b c Credit for increasing research activities . . . . . . . . . . . . . . . . . . 1c d Low-income housing credit (Form 8586, Part I only) (enter EIN if claiming this credit from a

pass-through entity: . . . . . . . . . . . . . . . .) 1d e Disabled access credit (Form 8826) (do not enter more than $5,000) . . . . . . . . . 1e f Renewable electricity production credit (Form 8835) (see instructions) . . . . . . . . 1f g Indian employment credit . . . . . . . . . . . . . . . . . . . . . . . 1g h Orphan drug credit (Form 8820) . . . . . . . . . . . . . . . . . . . . . 1h i New markets credit (Form 8874) (enter EIN if claiming this credit from a pass-through entity:

) . . . . . . . . . . . . . . . . . . . . . . . 1i j Credit for small employer pension plan startup costs (Form 8881) (do not enter more than $500) 1j k Credit for employer-provided child care facilities and services (Form 8882) (enter EIN if

claiming this credit from a pass-through entity: ) . . . . . 1k l Biodiesel and renewable diesel fuels credit (attach Form 8864) . . . . . . . . . . . 1l m Low sulfur diesel fuel production credit (Form 8896) . . . . . . . . . . . . . . 1m n Distilled spirits credit (Form 8906) . . . . . . . . . . . . . . . . . . . . 1n o Nonconventional source fuel credit (Form 8907) . . . . . . . . . . . . . . . 1o p Energy efficient home credit . . . . . . . . . . . . . . . . . . . . . . 1p q Energy efficient appliance credit (Form 8909) . . . . . . . . . . . . . . . . 1q r Alternative motor vehicle credit (Form 8910) (enter EIN if claiming this credit from a

pass-through entity: ) . . . . . . . . . . . . . . . 1r s Alternative fuel vehicle refueling property credit (Form 8911) . . . . . . . . . . . 1s t Employer housing credit . . . . . . . . . . . . . . . . . . . . . . . 1t u Mine rescue team training credit . . . . . . . . . . . . . . . . . . . . . 1u v Agricultural chemicals security credit (Form 8931) (do not enter more than $2 million) . . . 1v w Credit for employer differential wage payments . . . . . . . . . . . . . . . . 1w x Carbon dioxide sequestration credit (Form 8933) . . . . . . . . . . . . . . . 1x y Qualified plug-in electric drive motor vehicle credit (Form 8936) . . . . . . . . . . 1y z Qualified plug-in electric vehicle credit (Form 8834, Part I only) . . . . . . . . . . 1z aa New hire retention credit (Form 5884-B) . . . . . . . . . . . . . . . . . . 1aa bb General credits from an electing large partnership (Schedule K-1 (Form 1065-B)) . . . . . 1bb

2 Add lines 1a through 1bb . . . . . . . . . . . . . . . . . . . . . . . 2

3 Passive activity credits included on line 2 (see instructions) . . . . . . . . . . . . 3


5 Passive activity credits allowed for 2010 (see instructions) . . . . . . . . . . . . 5

6 Carryforward of general business credit to 2010. See instructions for the schedule to attach . 6

7 Carryback of general business credit from 2011 (see instructions) . . . . . . . . . 7

8 Add lines 4 through 7. Subtract from that sum any eligible small business credits and enter theresult (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 8

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 12392F Form 3800 (2010)


Form 3800 (2010) Page 2

Part II Allowable Credit

9 Regular tax before credits: • Individuals. Enter the amount from Form 1040, line 44 or Form 1040NR, line 42 .• Corporations. Enter the amount from Form 1120, Schedule J, line 2; or the

applicable line of your return . . . . . . . . . . . . . . . . . .• Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G,

lines 1a and 1b, or the amount from the applicable line of your return . . . .

} . . 9

10 Alternative minimum tax: • Individuals. Enter the amount from Form 6251, line 35 . . . . . . . .• Corporations. Enter the amount from Form 4626, line 14 . . . . . . . .• Estates and trusts. Enter the amount from Schedule I (Form 1041), line 56 . . } . . . 10

11 Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 a Foreign tax credit . . . . . . . . . . . . . . . . 12a b Personal credits from Form 1040 or 1040NR (see instructions) . 12b c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . . 12c

13 Net income tax. Subtract line 12c from line 11. If zero, skip lines 14 through 17 and enter -0- on line 18a 13

14 Net regular tax. Subtract line 12c from line 9. If zero or less, enter -0- 14

15 Enter 25% (.25) of the excess, if any, of line 14 over $25,000 (see instructions) . . . . . . . . . . . . . . . . . . 15

16 Tentative minimum tax. If line 8 is zero and line 24 would be zero, skip lines 16 through 25 and go to line 26. Otherwise, see instructions . . . . . . . . . . . . . . . . . . 16

17 Enter the greater of line 15 or line 16 . . . . . . . . . . . . . . . . . . . . 17

18a Subtract line 17 from line 13. If zero or less, enter -0- . . . . . . . . . . . . . . 18a b For a corporation electing to accelerate the research credit, enter the bonus depreciation

amount attributable to the research credit. (see instructions) . . . . . . . . . . . . 18b c Add lines 18a and 18b . . . . . . . . . . . . . . . . . . . . . . . . 18c

19a Enter the smaller of line 8 or line 18c . . . . . . . . . . . . . . . . . . . 19a C corporations: See the line 19a instructions if there has been an ownership change, acquisition, or reorganization.

b Enter the smaller of line 8 or line 18a. If you made an entry on line 18b, go to line 19c; otherwise, skip line 19c (see instructions) . . . . . . . . . . . . . . . . . . . . . . 19b

c Subtract line 19b from line 19a. This is the refundable amount for a corporation electing to accelerate the research credit. Include this amount on line 32g of Form 1120 (or the applicable line of your return) . . . . . . . . . . . . . . . . . . . . . . . . . . 19c

Form 3800 (2010)


Form 3800 (2010) Page 3

Part II Allowable Credit (Continued)

Note. If you are not filing Form 8844, skip lines 20 through 24 and enter -0- on line 25. 20 Multiply line 16 by 75% (see instructions) . . . . . . . . . . . . . . . . . . 20


22 Subtract line 21 from line 13. If zero or less, enter -0- . . . . . . . . . . . . . . 22

23 Subtract line 19b from line 22. If zero or less, enter -0- . . . . . . . . . . . . . . 23

24 Enter the amount from Form 8844, line 10 or line 12, excluding any portion of the credit that is an eligible small business credit (see instructions) . . . . . . . . . . . . . . . 24

25 Empowerment zone and renewal community employment credit allowed. Enter the smaller of line 23 or line 24 . . . . . . . . . . . . . . . . . . . . . . . . . . 25


27 If you skipped lines 16 through 25, enter -0-. Otherwise, add lines 19b and 25 . . . . . . 27


29a Enter the investment credit from Form 3468, Part III, line 20 (attach Form 3468) . . . . . . . . . . . . . . . . . . 29a

b Enter the work opportunity credit from Form 5884, line 10 or line 12 . . . . . . . . . . . . . . . . . . . . 29b

c Enter the alcohol and cellulosic biofuel fuels credit from Form 6478, line 15 or line 17 . . . . . . . . . . . . . . . . . 29c

d Enter the low-income housing credit from Form 8586, Part II, line 18 or line 20 . . . . . . . . . . . . . . . . . . . 29d

e Enter the applicable part of the amount of the renewable electricity, refined coal, and Indian coal production credit from Form 8835, Part II, line 36 or line 38 . . . . . . . . . . . . . . 29e

f Enter the credit for employer social security and Medicare taxes paid on certain employee tips from Form 8846, line 12 . . . . 29f

g Enter the qualified railroad track maintenance credit from Form 8900, line 12 . . . . . . . . . . . . . . . . . . 29g

h Enter the credit for small employer health insurance premiums fromForm 8941, line 21 or line 23 (tax-exempt entities, other than farmers' cooperatives, do not complete this line—see instructions) (enter EIN if claiming this credit from a pass-through entity:

) . . . . . . . . . . . . . 29h

30 Add lines 29a through 29h and increase that sum by any eligible small business credits and enter the result (see instructions) . . . . . . . . . . . . . . . . . . . . . 30

31 Enter the smaller of line 28 or line 30 . . . . . . . . . . . . . . . . . . . 31

32 Credit allowed for the current year. Add lines 27 and 31. Report the amount from line 32 (if smaller than the sum of lines 8, 24, and 30, see instructions) as indicated below or on the applicable line of your return:

• Individuals. Form 1040, line 53 or Form 1040NR, line 50 . . . . . . .• Corporations. Form 1120, Schedule J, line 5c . . . . . . . . . .• Estates and trusts. Form 1041, Schedule G, line 2b . . . . . . . .

} . . . 32

Form 3800 (2010)

credit limited



Moving Expenses


OMB No. 1545-0074



Before you begin: ✓ See the Distance Test and Time Test in the instructions to find out if you can deduct your moving expenses.

✓ See Members of the Armed Forces in the instructions, if applicable.

1 Transportation and storage of household goods and personal effects (see instructions) . . . 1 2 Travel (including lodging) from your old home to your new home (see instructions). Do not

include the cost of meals . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Enter the total amount your employer paid you for the expenses listed on lines 1 and 2 that is not included in box 1 of your Form W-2 (wages). This amount should be shown in box 12 of your Form W-2 with code P . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Is line 3 more than line 4?

No. You cannot deduct your moving expenses. If line 3 is less than line 4, subtract line 3 from line 4 and include the result on Form 1040, line 7, or Form 1040NR, line 8.

Yes. Subtract line 4 from line 3. Enter the result here and on Form 1040, line 26, or Form1040NR, line 26. This is your moving expense deduction . . . . . . . . . 5

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 12490K Form 3903 (2010)



Credit for Federal Tax Paid on Fuels▶ See the separate instructions.

▶ Attach this form to your income tax return.

OMB No. 1545-0162


Name (as shown on your income tax return) Taxpayer identification number

Caution. Claimant has the name and address of the person who sold the fuel to the claimant and the dates of purchase. For claims on lines 1c and 2b (type of use 13 and 14), 3d, 4c, and 5, claimant has not waived the right to make the claim. For claims on lines 1c and 2b (type of use 13 and 14), claimant certifies that a certificate has not been provided to the credit card issuer.

1 Nontaxable Use of Gasoline Note. CRN is credit reference number.

(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN

a Off-highway business use

b Use on a farm for farming purposes 362

c Other nontaxable use (see Caution above line 1) $

d Exported 411

}

2 Nontaxable Use of Aviation Gasoline


a Use in commercial aviation (other than foreign trade) $ 354

b Other nontaxable use (see Caution above line 1) 324

c Exported 412

d LUST tax on aviation fuels used in foreign trade 433

*See instructions for possible rate changes.

3 Nontaxable Use of Undyed Diesel Fuel

Claimant certifies that the diesel fuel did not contain visible evidence of dye. Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach an explanation and check here ▶


a Nontaxable use

b Use on a farm for farming purposes $ 360

c Use in trains 353d Use in certain intercity and local buses (see Caution

above line 1) 350

e Exported 413

}

4 Nontaxable Use of Undyed Kerosene (Other Than Kerosene Used in Aviation)

Claimant certifies that the kerosene did not contain visible evidence of dye. Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach an explanation and check here ▶


a Nontaxable use taxed at $.244

b Use on a farm for farming purposes $ 346c Use in certain intercity and local buses (see Caution

above line 1) 347

d Exported 414

e Nontaxable use taxed at $.044 377

f Nontaxable use taxed at $.219 369

}

For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 12625R Form 4136 (2010)


Form 4136 (2010) Page 2

5 Kerosene Used in Aviation (see Caution above line 1)


a Kerosene used in commercial aviation (other than foreign trade) taxed at $.244 $ 417

b Kerosene used in commercial aviation (other than foreign trade) taxed at $.219* 355

c Nontaxable use (other than use by state or local government) taxed at $.244 346

d Nontaxable use (other than use by state or local government) taxed at $.219* 369

e LUST tax on aviation fuels used in foreign trade 433


6 Sales by Registered Ultimate Vendors of Undyed Diesel Fuel Registration No. ▶

Claimant certifies that it sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the written consent of the buyer to make the claim. Claimant certifies that the diesel fuel did not contain visible evidence of dye.

Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach an explanation and check here . . . ▶

(b) Rate (c) Gallons (d) Amount of credit (e) CRN

a Use by a state or local government $ 360

b Use in certain intercity and local buses 350

7 Sales by Registered Ultimate Vendors of Undyed Kerosene (Other Than Kerosene For Use in Aviation) Registration No. ▶

Claimant certifies that it sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the written consent of the buyer to make the claim. Claimant certifies that the kerosene did not contain visible evidence of dye.

Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach an explanation and check here . . . . ▶


a Use by a state or local government

b Sales from a blocked pump $ 346

c Use in certain intercity and local buses 347

}

8 Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation Registration No. ▶

Claimant sold the kerosene for use in aviation at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the amount of tax to the buyer, or has obtained the written consent of the buyer to make the claim. See the instructions for additional information to be submitted.


a Use in commercial aviation (other than foreign trade) taxed at $.219* $ 355

b Use in commercial aviation (other than foreign trade) taxed at $.244 417

c Nonexempt use in noncommercial aviation 418

d Other nontaxable uses taxed at $.244 346

e Other nontaxable uses taxed at $.219* 369

f LUST tax on aviation fuels used in foreign trade 433


Form 4136 (2010)


Form 4136 (2010) Page 3

9 Alcohol Fuel Mixture Credit Registration No. ▶

Claimant produced an alcohol fuel mixture by mixing taxable fuel with alcohol. The alcohol fuel mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant.

(b) Rate (c) Gallons of alcohol

(d) Amount of credit (e) CRN

a Alcohol fuel mixtures containing ethanol $ 393

b Alcohol fuel mixtures containing alcohol (other than ethanol) 394

10 Biodiesel or Renewable Diesel Mixture Credit Registration No. ▶

Biodiesel mixtures. Claimant produced a mixture by mixing biodiesel with diesel fuel. The biodiesel used to produce the mixture met ASTM D6751 and met EPA’s registration requirements for fuels and fuel additives. The mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant. Claimant has attached the Certificate for Biodiesel and, if applicable, the Statement of Biodiesel Reseller. Renewable diesel mixtures. Claimant produced a mixture by mixing renewable diesel with liquid fuel (other than renewable diesel). The renewable diesel used to produce the renewable diesel mixture was derived from biomass process, met EPA’s registration requirements for fuels and fuel additives, and met ASTM D975, D396, or other equivalent standard approved by the IRS. The mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant. Claimant has attached the Certificate for Biodiesel and, if applicable, the Statement of Biodiesel Reseller, both of which have been edited as discussed in the Instructions for Form 4136. See the instructions for line 10 for information about renewable diesel used in aviation.

(b) Rate (c) Gallons of biodiesel or renewable

diesel


a Biodiesel (other than agri-biodiesel) mixtures $ 388

b Agri-biodiesel mixtures 390

c Renewable diesel mixtures 307

11 Nontaxable Use of Alternative FuelCaution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5) (see instructions).

(a) Type of use (b) Rate (c) Gallons or gasoline

gallon equivalents (GGE)


a Liquefied petroleum gas (LPG) $ 419

b “P Series” fuels 420

c Compressed natural gas (CNG) (GGE = 126.67 cu. ft.) 421

d Liquefied hydrogen 422

e Any liquid fuel derived from coal (including peat) through the Fischer-Tropsch process 423

f Liquid fuel derived from biomass 424

g Liquefied natural gas (LNG) 425

h Liquefied gas derived from biomass 435

12 Alternative Fuel Credit and Alternative Fuel Mixture Credit Registration No. ▶

(b) Rate (c) Gallons or gasoline

gallon equivalents (GGE)


a Liquefied petroleum gas (LPG) $ 426

b “P Series” fuels 427

c Compressed natural gas (CNG) (GGE = 121 cu. ft.) 428

d Liquefied hydrogen 429

e Any liquid fuel derived from coal (including peat) through the Fischer-Tropsch process 430

f Liquid fuel derived from biomass 431

g Liquefied natural gas (LNG) 432

h Liquefied gas derived from biomass 436

i Compressed gas derived from biomass (GGE = 121 cu. ft.) 437

Form 4136 (2010)


Form 4136 (2010) Page 4

13 Registered Credit Card Issuers Registration No. ▶


a Diesel fuel sold for the exclusive use of a state or local government $ 360

b Kerosene sold for the exclusive use of a state or local government 346

c Kerosene for use in aviation sold for the exclusive use of a state or local government taxed at $.219* 369


14 Nontaxable Use of a Diesel-Water Fuel Emulsion

Caution. There is a reduced credit rate for use in certain intercity and local buses (type of use 5) (see instructions).


a Nontaxable use $ 309

b Exported 306

15 Diesel-Water Fuel Emulsion Blending Registration No. ▶


Blender credit $ 310

16 Exported Dyed Fuels and Exported Gasoline Blendstocks


a Exported dyed diesel fuel and exported gasoline blendstocks taxed at $.001 $ 415

b Exported dyed kerosene 416

17 Total income tax credit claimed. Add lines 1 through 16, column (d). Enter here and on Form 1040, line 70; Form 1120, line 32f(2); Form 1120S, line 23c; Form 1041, line 24g; or the proper line of other returns. ▶ 17 $

Form 4136 (2010)



Social Security and Medicare Tax on Unreported Tip Income

▶ See instructions below and on back.▶ Attach to Form 1040, Form 1040NR, Form 1040NR-EZ, Form 1040-SS, or Form 1040-PR.

OMB No. 1545-0074


Name of person who received tips. If married, complete a separate Form 4137 for each spouse with unreported tips. Social security number

1 (a) Name of employer to whom you were required to, but did not

report all your tips (see instructions)

(b) Employer identification number

(see instructions)

(c) Total cash and charge tips you received (including

unreported tips) (see instructions)

(d) Total cash and charge tips you reported to your

employer

A

B

C

D

E 2 Total cash and charge tips you received in 2010. Add the

amounts from line 1, column (c) . . . . . . . . . . . 2 3 Total cash and charge tips you reported to your employer(s) in 2010. Add the amounts from

line 1, column (d) . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Subtract line 3 from line 2. This amount is income you must include in the total on Form 1040,

line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3 . . . . . . . . . . . . . 45 Cash and charge tips you received but did not report to your employer because the total was

less than $20 in a calendar month (see instructions). . . . . . . . . . . . . . . 5

6 Unreported tips subject to Medicare tax. Subtract line 5 from line 4 . . . . . . . . . 6 7 Maximum amount of wages (including tips) subject to

social security tax . . . . . . . . . . . . . . . . 7 106,800 00 8 Total social security wages and social security tips (total of boxes

3 and 7 shown on your Form(s) W-2) or railroad retirement (tier 1) compensation . . . . . . . . . . . . . . . . . 8

9 Subtract line 8 from line 7. If line 8 is more than line 7, enter -0- here and on line 10 and go to line 12. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Unreported tips subject to social security tax. Enter the smaller of line 6 or line 9. If youreceived tips as a federal, state, or local government employee, see instructions . . . . . 10

11 Multiply line 10 by .062 (social security tax rate) . . . . . . . . . . . . . . . . 11 12 Multiply line 6 by .0145 (Medicare tax rate). . . . . . . . . . . . . . . . . . 12 13 Add lines 11 and 12. Enter the result here and on Form 1040, line 57; Form 1040NR, line 55; or

Form 1040NR-EZ, line 16 (Form 1040-SS and 1040-PR filers, see instructions.) . . . . . 13

General Instructions Purpose of form. Use Form 4137 only to figure the social security and Medicare tax owed on tips you did not report to your employer, including any allocated tips shown on your Form(s) W-2 that you must report as income. You must also report the income on Form 1040, line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3. By filing this form, your social security and Medicare tips will be credited to your social security record (used to figure your benefits).

▲!CAUTION

If you believe you are an employee and you received Form 1099-MISC, Miscellaneous Income, instead of Form W-2, Wage and Tax Statement, because your employer did not consider you an

employee, do not use this form to report the social security and Medicare tax on that income. Instead, use Form 8919, Uncollected Social Security and Medicare Tax on Wages.

Who must file. You must file Form 4137 if you received cash and charge tips of $20 or more in a calendar month and did not report all of those tips to your employer. You must also file Form 4137 if box 8 of your Form(s) W-2 shows allocated tips that you must report as income.Allocated tips. You must report as income on Form 1040, line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3, at least the amount of allocated tips shown in box 8 of your Form(s) W-2 unless you can prove a smaller amount with adequate records. If you have records that show the actual amount of tips you received, report that amount even if it is more or less than the allocated tips. Although allocated tips are shown on your Form W-2, they are not included in the wages, tips, and other compensation box (box 1) on that form and no income tax, social security tax, or Medicare tax has been withheld from these tips.

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 12626C Form 4137 (2010)



Depreciation and Amortization (Including Information on Listed Property)

▶ See separate instructions. ▶ Attach to your tax return.

OMB No. 1545-0172


Name(s) shown on return Business or activity to which this form relates Identifying number

Part I Election To Expense Certain Property Under Section 179 Note: If you have any listed property, complete Part V before you complete Part I.

1 Maximum amount (see instructions) . . . . . . . . . . . . . . . . . . . . . . . 12 Total cost of section 179 property placed in service (see instructions) . . . . . . . . . . . 23 Threshold cost of section 179 property before reduction in limitation (see instructions) . . . . . . 34 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0- . . . . . . . . . . 45 Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If married filing

separately, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . 56 (a) Description of property (b) Cost (business use only) (c) Elected cost

7 Listed property. Enter the amount from line 29 . . . . . . . . . 78 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 . . . . . . 89 Tentative deduction. Enter the smaller of line 5 or line 8 . . . . . . . . . . . . . . . . 9

10 Carryover of disallowed deduction from line 13 of your 2009 Form 4562 . . . . . . . . . . . 1011 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 1112 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 . . . . . 1213 Carryover of disallowed deduction to 2011. Add lines 9 and 10, less line 12 ▶ 13

Note: Do not use Part II or Part III below for listed property. Instead, use Part V.

Part II Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions.)14 Special depreciation allowance for qualified property (other than listed property) placed in service

during the tax year (see instructions) . . . . . . . . . . . . . . . . . . . . . . 1415 Property subject to section 168(f)(1) election . . . . . . . . . . . . . . . . . . . . 1516 Other depreciation (including ACRS) . . . . . . . . . . . . . . . . . . . . . . 16Part III MACRS Depreciation (Do not include listed property.) (See instructions.)

Section A17 MACRS deductions for assets placed in service in tax years beginning before 2010 . . . . . . . 1718 If you are electing to group any assets placed in service during the tax year into one or more general

asset accounts, check here . . . . . . . . . . . . . . . . . . . . ▶

Section B—Assets Placed in Service During 2010 Tax Year Using the General Depreciation System

(a) Classification of property(b) Month and year

placed in service

(c) Basis for depreciation (business/investment use

only—see instructions)

(d) Recovery period

(e) Convention (f) Method (g) Depreciation deduction

19a 3-year propertyb 5-year propertyc 7-year propertyd 10-year propertye 15-year propertyf 20-year propertyg 25-year propertyh Residential rental

property i Nonresidential real

property Section C—Assets Placed in Service During 2010 Tax Year Using the Alternative Depreciation System

20a Class lifeb 12-yearc 40-year

Part IV Summary (See instructions.)21 Listed property. Enter amount from line 28 . . . . . . . . . . . . . . . . . . . . 2122 Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here

and on the appropriate lines of your return. Partnerships and S corporations—see instructions . . . . . 2223 For assets shown above and placed in service during the current year, enter the

portion of the basis attributable to section 263A costs . . . . . . . 23For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 12906N Form 4562 (2010)

undeterm'd type

total GDS cost

undeterm'd type

total GDS deduct.

total ADS deduct. total ADS cost

EPZONE


Form 4562 (2010) Page 2 Part V Listed Property (Include automobiles, certain other vehicles, certain computers, and property used for

entertainment, recreation, or amusement.)Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a, 24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable.

Section A—Depreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.)24a Do you have evidence to support the business/investment use claimed? Yes No 24b If “Yes,” is the evidence written? Yes No

(a) Type of property (list

vehicles first)

(b) Date placed

in service

(c) Business/

investment use percentage

(d) Cost or other basis

(e) Basis for depreciation (business/investment

use only)

(f) Recovery

period

(g) Method/

Convention

(h) Depreciation

deduction

(i) Elected section 179

cost

25 Special depreciation allowance for qualified listed property placed in service during the tax year and used more than 50% in a qualified business use (see instructions) . 25

26 Property used more than 50% in a qualified business use:% % %

27 Property used 50% or less in a qualified business use:% S/L –% S/L –% S/L –

28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 . 28 29 Add amounts in column (i), line 26. Enter here and on line 7, page 1 . . . . . . . . . . . . 29

Section B—Information on Use of VehiclesComplete this section for vehicles used by a sole proprietor, partner, or other “more than 5% owner,” or related person. If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles.

30 Total business/investment miles driven during the year (do not include commuting miles) .

(a) Vehicle 1

(b) Vehicle 2

(c) Vehicle 3

(d) Vehicle 4

(e) Vehicle 5

(f) Vehicle 6

31 Total commuting miles driven during the year32 Total other personal (noncommuting) miles

driven . . . . . . . . . . . .

33 Total miles driven during the year. Add lines 30 through 32 . . . . . . . . .

Yes No Yes No Yes No Yes No Yes No Yes No34 Was the vehicle available for personal use during off-duty hours? . . . . . . .

35 Was the vehicle used primarily by a more than 5% owner or related person? . . .

36 Is another vehicle available for personal use? Section C—Questions for Employers Who Provide Vehicles for Use by Their Employees

Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5% owners or related persons (see instructions).37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by

your employees? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Yes No

38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners . . . .

39 Do you treat all use of vehicles by employees as personal use? . . . . . . . . . . . . . . . .40 Do you provide more than five vehicles to your employees, obtain information from your employees about the

use of the vehicles, and retain the information received? . . . . . . . . . . . . . . . . . . .

41 Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.) . . .Note: If your answer to 37, 38, 39, 40, or 41 is “Yes,” do not complete Section B for the covered vehicles.

Part VI Amortization

(a) Description of costs

(b) Date amortization

begins

(c) Amortizable amount

(d) Code section

(e) Amortization

period or percentage

(f) Amortization for this year

42 Amortization of costs that begins during your 2010 tax year (see instructions):

43 Amortization of costs that began before your 2010 tax year . . . . . . . . . . . . . 43 44 Total. Add amounts in column (f). See the instructions for where to report . . . . . . . . 44

Form 4562 (2010)

total basis26e + 27e

total cost


Form 4684Department of theTreasury Internal Revenue Service

Casualties and Thefts▶ See separate instructions. ▶ Attach to your tax return.

▶ Use a separate Form 4684 for each casualty or theft.

OMB No. 1545-0177


Name(s) shown on tax return Identifying number

SECTION A—Personal Use Property (Use this section to report casualties and thefts of property not used in a trade or business or for income-producing purposes.)

1 Description of properties (show type, location, and date acquired for each property). Use a separate line for each property lost or damaged from the same casualty or theft.

Property A

Property B

Property C

Property DProperties

A B C D2 Cost or other basis of each property . . . . . . 2

3 Insurance or other reimbursement (whether or not you filed a claim) (see instructions) . . . . . . . . 3

Note: If line 2 is more than line 3, skip line 4.

4 Gain from casualty or theft. If line 3 is more than line 2, enter the difference here and skip lines 5 through 9 for that column. See instructions if line 3 includes insurance or other reimbursement you did not claim, or you received payment for your loss in a later tax year . . 4

5 Fair market value before casualty or theft . . . . 5

6 Fair market value after casualty or theft . . . . . 6

7 Subtract line 6 from line 5 . . . . . . . . . 7

8 Enter the smaller of line 2 or line 7 . . . . . . 8

9 Subtract line 3 from line 8. If zero or less, enter -0- . . 9

10 Casualty or theft loss. Add the amounts on line 9 in columns A through D . . . . . . . . . . . . . 10

11 Enter the smaller of line 10 or $100 . . . . . . . . . . . . . . . . . . . . . . . . 11

12 Subtract line 11 from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Caution: Use only one Form 4684 for lines 13 through 21.

13 Add the amounts on line 12 of all Forms 4684 . . . . . . . . . . . . . . . . . . . . . 13

14 Add the amounts on line 4 of all Forms 4684. . . . . . . . . . . . . . . . . . . . . . 14

15 • If line 14 is more than line 13, enter the difference here and on Schedule D. Do not complete the rest of this section (see instructions).

• If line 14 is less than line 13, enter -0- here and go to line 16.

• If line 14 is equal to line 13, enter -0- here. Do not complete the rest of this section.} . . . . . . . 15

16 If line 14 is less than line 13, enter the difference . . . . . . . . . . . . . . . . . . . . 16

17

Does the amount on line 12 include a loss from a disaster declared a federal disaster in tax years beginning after 2007 that occurred before 2010?

Yes. Enter the amount from line 3 of the Worksheet for Line 17, in the instructions. If you are filing Schedule A (Form 1040), go to line 18. Otherwise, enter this amount on Schedule L (Form 1040A or 1040). Do not complete the rest of Section A. Form 1040NR filers, see instructions.

No. Enter -0- and go to line 18 . . . . . . . . . . . . . . . . . . . . . . . . 17


19 Enter 10% of your adjusted gross income from Form 1040, line 38, or Form 1040NR, line 36. Estates and trusts, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

20 Subtract line 19 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . 20

21 Add lines 17 and 20. Also enter the result on Schedule A (Form 1040), line 20, or Form 1040NR, Schedule A, line 8. Estates and trusts, enter the result on the “Other deductions” line of your tax return . . . . . . . . . . 21

For Paperwork Reduction Act Notice, see page 5 of the instructions. Cat. No. 12997O Form 4684 (2010)


Form 4684 (2010) Attachment Sequence No. 26 Page 2Name(s) shown on tax return. Do not enter name and identifying number if shown on other side. Identifying number

SECTION B—Business and Income-Producing PropertyPart I Casualty or Theft Gain or Loss (Use a separate Part l for each casualty or theft.)


Property A

Property B

Property C


A B C D23 Cost or adjusted basis of each property . . . . . 23 24 Insurance or other reimbursement (whether or not you

filed a claim). See the instructions for line 3 . . . . 24 Note: If line 23 is more than line 24, skip line 25.

25 Gain from casualty or theft. If line 24 is more than line 23, enter the difference here and on line 32 or line 37, column (c), except as provided in the instructions for line 36. Also, skip lines 26 through 30 for that column. See the instructions for line 4 if line 24 includes insurance or other reimbursement you did not claim, or you received payment for your loss in a later tax year . . . . 25



28 Subtract line 27 from line 26 . . . . . . . . 28

29 Enter the smaller of line 23 or line 28 . . . . . 29

Note: If the property was totally destroyed by casualty or lost from theft, enter on line 29 the amount from line 23.

30 Subtract line 24 from line 29. If zero or less, enter -0- 3031 Casualty or theft loss. Add the amounts on line 30. Enter the total here and on line 32 or line 37 (see instructions) . . 31

Part II Summary of Gains and Losses (from separate Parts l) (b) Losses from casualties or thefts

(a) Identify casualty or theft(i) Trade, business,

rental or royalty property

(ii) Income- producing and

employee property

(c) Gains from casualties or thefts includible in income

Casualty or Theft of Property Held One Year or Less32

( ) ( )

( ) ( )

33 Totals. Add the amounts on line 32 . . . . . . . . . . . . 33 ( ) ( )

34 Combine line 33, columns (b)(i) and (c). Enter the net gain or (loss) here and on Form 4797, line 14. If Form 4797 is not otherwise required, see instructions . . . . . . . . . . . . . . . . . . . . . . . 34

35 Enter the amount from line 33, column (b)(ii) here. Individuals, enter the amount from income-producing property on Schedule A (Form 1040), line 28, or Form 1040NR, Schedule A, line 16, and enter the amount from property used as an employee on Schedule A (Form 1040), line 23, or Form 1040NR, Schedule A, line 11. Estates and trusts, partnerships, and S corporations, see instructions . . . . 35

Casualty or Theft of Property Held More Than One Year36 Casualty or theft gains from Form 4797, line 32 . . . . . . . . . . . . . . . . . . . . . . . . . 36 37 ( ) ( )

( ) ( )

38 Total losses. Add amounts on line 37, columns (b)(i) and (b)(ii) . . . . . 38 ( ) ( )

39 Total gains. Add lines 36 and 37, column (c) . . . . . . . . . . . . . . . . . . . . . . 39

40 Add amounts on line 38, columns (b)(i) and (b)(ii) . . . . . . . . . . . . . . . . . . . . 40

41 If the loss on line 40 is more than the gain on line 39:a Combine line 38, column (b)(i) and line 39, and enter the net gain or (loss) here. Partnerships (except electing large

partnerships) and S corporations, see the note below. All others, enter this amount on Form 4797, line 14. If Form 4797 is not otherwise required, see instructions . . . . . . . . . . . . . . . . . . . . . 41a

b Enter the amount from line 38, column (b)(ii) here. Individuals, enter the amount from income-producing property on Schedule A (Form 1040), line 28, or Form 1040NR, Schedule A, line 16, and enter the amount from property used as an employee on Schedule A (Form 1040), line 23, or Form 1040NR, Schedule A, line 11. Estates and trusts, enter on the “Other deductions” line of your tax return. Partnerships (except electing large partnerships) and S corporations, see the note below. Electing large partnerships, enter on Form 1065-B, Part II, line 11 . . . . . . . . . 41b

42 If the loss on line 40 is less than or equal to the gain on line 39, combine lines 39 and 40 and enter here. Partnerships (except electing large partnerships), see the note below. All others, enter this amount on Form 4797, line 3 . . . . 42

Note: Partnerships, enter the amount from line 41a, 41b, or line 42 on Form 1065, Schedule K, line 11. S corporations, enter the amount from line 41a or 41b on Form 1120S, Schedule K, line 10.

Form 4684 (2010)



Sales of Business Property (Also Involuntary Conversions and Recapture Amounts

Under Sections 179 and 280F(b)(2))▶ Attach to your tax return. ▶ See separate instructions.

OMB No. 1545-0184


2010Name(s) shown on return Identifying number

1 Enter the gross proceeds from sales or exchanges reported to you for 2010 on Form(s) 1099-B or 1099-S (or substitute statement) that you are including on line 2, 10, or 20 (see instructions) . . . . . . . . 1

Part I Sales or Exchanges of Property Used in a Trade or Business and Involuntary Conversions From Other Than Casualty or Theft—Most Property Held More Than 1 Year (see instructions)

2 (a) Description of property

(b) Date acquired (mo., day, yr.)

(c) Date sold (mo., day, yr.)

(d) Gross sales price

(e) Depreciation allowed or

allowable since acquisition

(f) Cost or other basis, plus

improvements and expense of sale

(g) Gain or (loss) Subtract (f) from the

sum of (d) and (e)

3 Gain, if any, from Form 4684, line 42 . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Section 1231 gain from installment sales from Form 6252, line 26 or 37 . . . . . . . . . . . . . . 4

5 Section 1231 gain or (loss) from like-kind exchanges from Form 8824 . . . . . . . . . . . . . . 5

6 Gain, if any, from line 32, from other than casualty or theft. . . . . . . . . . . . . . . . . . 6

7 Combine lines 2 through 6. Enter the gain or (loss) here and on the appropriate line as follows: . . . . . . . 7Partnerships (except electing large partnerships) and S corporations. Report the gain or (loss) following the instructions for Form 1065, Schedule K, line 10, or Form 1120S, Schedule K, line 9. Skip lines 8, 9, 11, and 12 below.

Individuals, partners, S corporation shareholders, and all others. If line 7 is zero or a loss, enter the amount from line 7 on line 11 below and skip lines 8 and 9. If line 7 is a gain and you did not have any prior year section 1231 losses, or they were recaptured in an earlier year, enter the gain from line 7 as a long-term capital gain on the Schedule D filed with your return and skip lines 8, 9, 11, and 12 below.

8 Nonrecaptured net section 1231 losses from prior years (see instructions) . . . . . . . . . . . . . 8

9 Subtract line 8 from line 7. If zero or less, enter -0-. If line 9 is zero, enter the gain from line 7 on line 12 below. If line 9 is more than zero, enter the amount from line 8 on line 12 below and enter the gain from line 9 as a long-term capital gain on the Schedule D filed with your return (see instructions) . . . . . . . . . . . . . . 9

Part II Ordinary Gains and Losses (see instructions)10 Ordinary gains and losses not included on lines 11 through 16 (include property held 1 year or less):

11 Loss, if any, from line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 ( )

12 Gain, if any, from line 7 or amount from line 8, if applicable . . . . . . . . . . . . . . . . . 12

13 Gain, if any, from line 31 . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

14 Net gain or (loss) from Form 4684, lines 34 and 41a . . . . . . . . . . . . . . . . . . . 14

15 Ordinary gain from installment sales from Form 6252, line 25 or 36 . . . . . . . . . . . . . . . 15

16 Ordinary gain or (loss) from like-kind exchanges from Form 8824. . . . . . . . . . . . . . . . 16

17 Combine lines 10 through 16 . . . . . . . . . . . . . . . . . . . . . . . . . . 17

18 For all except individual returns, enter the amount from line 17 on the appropriate line of your return and skip lines a and b below. For individual returns, complete lines a and b below:

a If the loss on line 11 includes a loss from Form 4684, line 38, column (b)(ii), enter that part of the loss here. Enter the part of the loss from income-producing property on Schedule A (Form 1040), line 28, and the part of the loss from property used as an employee on Schedule A (Form 1040), line 23. Identify as from “Form 4797, line 18a.” See instructions . . 18a

b Redetermine the gain or (loss) on line 17 excluding the loss, if any, on line 18a. Enter here and on Form 1040, line 14 18bFor Paperwork Reduction Act Notice, see separate instructions. Cat. No. 13086I Form 4797 (2010)

Official Use Only


Form 4797 (2010) Page 2Part III Gain From Disposition of Property Under Sections 1245, 1250, 1252, 1254, and 1255

(see instructions)

19 (a) Description of section 1245, 1250, 1252, 1254, or 1255 property: (b) Date acquired (mo., day, yr.)


A

B

C

D

These columns relate to the properties on lines 19A through 19D. ▶Property A Property B Property C Property D

20 Gross sales price (Note: See line 1 before completing.) . 20

21 Cost or other basis plus expense of sale . . . . . 21

22 Depreciation (or depletion) allowed or allowable . . . 22

23 Adjusted basis. Subtract line 22 from line 21. . . . 23

24 Total gain. Subtract line 23 from line 20 . . . . . 24

25 If section 1245 property:

a Depreciation allowed or allowable from line 22 . . . 25a

b Enter the smaller of line 24 or 25a . . . . . . 25b

26 If section 1250 property: If straight line depreciation was used, enter -0- on line 26g, except for a corporation subject to section 291.

a Additional depreciation after 1975 (see instructions) . 26a

b Applicable percentage multiplied by the smaller of line 24 or line 26a (see instructions) . . . . . . . 26b

c Subtract line 26a from line 24. If residential rental property or line 24 is not more than line 26a, skip lines 26d and 26e 26c

d Additional depreciation after 1969 and before 1976. . 26d

e Enter the smaller of line 26c or 26d . . . . . . 26e

f Section 291 amount (corporations only) . . . . . 26fg Add lines 26b, 26e, and 26f. . . . . . . . . 26g

27 If section 1252 property: Skip this section if you did not dispose of farmland or if this form is being completed for a partnership (other than an electing large partnership).

a Soil, water, and land clearing expenses . . . . . 27a

b Line 27a multiplied by applicable percentage (see instructions) 27bc Enter the smaller of line 24 or 27b . . . . . . 27c


a Intangible drilling and development costs, expenditures for development of mines and other natural deposits, mining exploration costs, and depletion (see instructions) . . . . . . . . . . . . . 28a



a Applicable percentage of payments excluded from income under section 126 (see instructions) . . . . 29a

b Enter the smaller of line 24 or 29a (see instructions) . 29bSummary of Part III Gains. Complete property columns A through D through line 29b before going to line 30.

30 Total gains for all properties. Add property columns A through D, line 24 . . . . . . . . . . . . . 3031 Add property columns A through D, lines 25b, 26g, 27c, 28b, and 29b. Enter here and on line 13 . . . . . . 31

32 Subtract line 31 from line 30. Enter the portion from casualty or theft on Form 4684, line 36. Enter the portion from other than casualty or theft on Form 4797, line 6 . . . . . . . . . . . . . . . . . . . . 32

Part IV Recapture Amounts Under Sections 179 and 280F(b)(2) When Business Use Drops to 50% or Less (see instructions)

(a) Section 179

(b) Section 280F(b)(2)

33 Section 179 expense deduction or depreciation allowable in prior years. . . . . . . . 33

34 Recomputed depreciation (see instructions) . . . . . . . . . . . . . . . . 3435 Recapture amount. Subtract line 34 from line 33. See the instructions for where to report . . 35

Form 4797 (2010)

Official Use Only



Farm Rental Income and Expenses(Crop and Livestock Shares (Not Cash) Received by Landowner (or Sub-Lessor))

(Income not subject to self-employment tax)▶ Attach to Form 1040 or Form 1040NR. ▶ See instructions on page 3.

OMB No. 1545-0074


Name(s) shown on tax return Your social security number

Employer ID number (EIN), if any

A Did you actively participate in the operation of this farm during 2010 (see instructions)? . . . . . . . Yes No

Part I Gross Farm Rental Income—Based on Production. Include amounts converted to cash or the equivalent.

1 Income from production of livestock, produce, grains, and other crops . . . . . . . . 1 2 a Cooperative distributions (Form(s) 1099-PATR) 2a 2b Taxable amount 2b3 a Agricultural program payments (see instructions) 3a 3b Taxable amount 3b4 Commodity Credit Corporation (CCC) loans (see instructions):

a CCC loans reported under election . . . . . . . . . . . . . . . . . . . 4a b CCC loans forfeited . . . . . . . . 4b 4c Taxable amount 4c

5 Crop insurance proceeds and federal crop disaster payments (see instructions):a Amount received in 2010 . . . . . . . 5a 5b Taxable amount 5bc If election to defer to 2011 is attached, check here ▶ 5d Amount deferred from 2009 5d

6 Other income, including federal and state gasoline or fuel tax credit or refund (see instructions) 6 7 Gross farm rental income. Add amounts in the right column for lines 1 through 6. Enter the

total here and on Schedule E (Form 1040), line 42. . . . . . . . . . . . . . . ▶ 7

Part II Expenses—Farm Rental Property. Do not include personal or living expenses.

8 Car and truck expenses (see Schedule F (Form 1040) instructions). Also attach Form 4562 8

9 Chemicals . . . . . . . 9 10 Conservation expenses (see

instructions) . . . . . . 10 11 Custom hire (machine work) . 11 12 Depreciation and section 179

expense deduction not claimed elsewhere . . . . 12

13 Employee benefit programs other than on line 21 (see Schedule F (Form 1040) instructions). . . 13

14 Feed . . . . . . . . 14 15 Fertilizers and lime . . . . 15 16 Freight and trucking . . . 16 17 Gasoline, fuel, and oil . . . 17 18 Insurance (other than health). 18 19 Interest:

a Mortgage (paid to banks, etc.) 19ab Other . . . . . . . . 19b

20 Labor hired (less employment credits) (see Schedule F (Form 1040) instructions) . . . . 20

21 Pension and profit-sharing plans . . . 21

22 Rent or lease:a Vehicles, machinery, and

equipment (see instructions) . . . . 22a

b Other (land, animals, etc.) 22b23 Repairs and maintenance 23 24 Seeds and plants . . 24 25 Storage and warehousing 25 26 Supplies . . . . . 26 27 Taxes . . . . . . 27 28 Utilities . . . . . 28 29 Veterinary, breeding,

and medicine . . . 29 30 Other expenses

(specify):

a 30ab 30bc 30cd 30de 30ef 30fg 30g

31 Total expenses. Add lines 8 through 30g (see instructions) . . . . . . . . . . . ▶ 31 32 Net farm rental income or (loss). Subtract line 31 from line 7. If the result is income, enter it

here and on Schedule E (Form 1040), line 40. If the result is a loss, you must go to line 33 . 32 33 If line 32 is a loss, check the box that describes your investment in this activity

(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . } 33a All investment is at risk.


c You may have to complete Form 8582 to determine your deductible loss, regardless of which box you checked (see instructions). If you checked box 33b, you must complete Form 6198 before going to Form 8582. In either case, enter the deductible loss here and on Schedule E(Form 1040), line 40 . . . . . . . . . . . . . . . . . . . . . . . . 33c

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 13117W Form 4835 (2010)

number of form 4835s attached

other expenses

investment risk

nondeductible loss/suspended loss carryover



Investment Interest Expense Deduction ▶ Attach to your tax return.

OMB No. 1545-0191



Part I Total Investment Interest Expense 1 Investment interest expense paid or accrued in 2010 (see instructions) . . . . . . . . 1 2 Disallowed investment interest expense from 2009 Form 4952, line 7 . . . . . . . . . 2 3 Total investment interest expense. Add lines 1 and 2 . . . . . . . . . . . . . . 3

Part II Net Investment Income 4 a Gross income from property held for investment (excluding any net

gain from the disposition of property held for investment) . . . 4a b Qualified dividends included on line 4a . . . . . . . . . 4b c Subtract line 4b from line 4a . . . . . . . . . . . . . . . . . . . . . . 4c d Net gain from the disposition of property held for investment . . 4d e Enter the smaller of line 4d or your net capital gain from the

disposition of property held for investment (see instructions) . 4e f Subtract line 4e from line 4d . . . . . . . . . . . . . . . . . . . . . . 4f g Enter the amount from lines 4b and 4e that you elect to include in investment income (see

instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4gh Investment income. Add lines 4c, 4f, and 4g . . . . . . . . . . . . . . . . . 4h

5 Investment expenses (see instructions) . . . . . . . . . . . . . . . . . . . 5 6 Net investment income. Subtract line 5 from line 4h. If zero or less, enter -0- . . . . . . 6

Part III Investment Interest Expense Deduction 7 Disallowed investment interest expense to be carried forward to 2011. Subtract line 6 from

line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . 7 8 Investment interest expense deduction. Enter the smaller of line 3 or 6. See instructions . . 8

Section references are to the Internal Revenue Code unless otherwise noted.

General Instructions Purpose of Form Use Form 4952 to figure the amount of investment interest expense you can deduct for 2010 and the amount you can carry forward to future years. Your investment interest expense deduction is limited to your net investment income.

For more information, see Pub. 550, Investment Income and Expenses.

Who Must File If you are an individual, estate, or a trust, you must file Form 4952 to claim a deduction for your investment interest expense. Exception. You do not have to file Form 4952 if all of the following apply. • Your investment income from interest and ordinary dividends minus any qualified dividends is more than your investment interest expense. • You do not have any other deductible investment expenses. • You do not have any carryover of disallowed investment interest expense from 2009.

Allocation of Interest Expense If you paid or accrued interest on a loan and used the loan proceeds for more than one purpose, you may have to allocate the interest. This is necessary because different

rules apply to investment interest, personal interest, trade or business interest, home mortgage interest, and passive activity interest. See Pub. 535, Business Expenses.

Specific Instructions Part I—Total Investment Interest Expense Line 1 Enter the investment interest expense paid or accrued during the tax year, regardless of when you incurred the indebtedness. Investment interest expense is interest paid or accrued on a loan or part of a loan that is allocable to property held for investment (as defined on this page).

Include investment interest expense reported to you on Schedule K-1 from a partnership or an S corporation. Include amortization of bond premium on taxable bonds purchased after October 22, 1986, but before January 1, 1988, unless you elected to offset amortizable bond premium against the interest payments on the bond. A taxable bond is a bond on which the interest is includible in gross income.

Investment interest expense does not include any of the following: • Home mortgage interest.

• Interest expense that is properly allocable to a passive activity. Generally, a passive activity is any trade or business activity in which you do not materially participate and any rental activity. See the Instructions for Form 8582, Passive Activity Loss Limitations, for details.

• Any interest expense that is capitalized, such as construction interest subject to section 263A. • Interest expense related to tax-exempt interest income under section 265. • Interest expense, disallowed under section 264, on indebtedness with respect to life insurance, endowment, or annuity contracts issued after June 8, 1997, even if the proceeds were used to purchase any property held for investment.Property held for investment. Property held for investment includes property that produces income, not derived in the ordinary course of a trade or business, from interest, dividends, annuities, or royalties. It also includes property that produces gain or loss, not derived in the ordinary course of a trade or business, from the disposition of property that produces these types of income or is held for investment. However, it does not include an interest in a passive activity.

Exception. A working interest in an oil or gas property that you held directly or through an entity that did not limit your liability is property held for investment, but only if you did not materially participate in the activity.

Part II—Net Investment IncomeLine 4aGross income from property held for investment includes income, unless derived in the ordinary course of a trade or business, from interest, ordinary dividends (except Alaska Permanent Fund dividends), annuities, and royalties. Include investment income

For Paperwork Reduction Act Notice, see back of form. Cat. No. 13177Y Form 4952 (2010)



Tax on Lump-Sum Distributions (From Qualified Plans of Participants Born Before January 2, 1936)

▶ Attach to Form 1040, Form 1040NR, or Form 1041.

OMB No. 1545-0193


Name of recipient of distribution Identifying number

Part I Complete this part to see if you can use Form 4972Yes No1 Was this a distribution of a plan participant’s entire balance (excluding deductible voluntary employee

contributions and certain forfeited amounts) from all of an employer’s qualified plans of one kind (pension, profit-sharing, or stock bonus)? If “No,” do not use this form . . . . . . . . . . . . . . . . 1

2 Did you roll over any part of the distribution? If “Yes,” do not use this form . . . . . . . . . . . 2

3 Was this distribution paid to you as a beneficiary of a plan participant who was born before January 2, 1936? 3 4 Were you (a) a plan participant who received this distribution, (b) born before January 2, 1936, and (c) a

participant in the plan for at least 5 years before the year of the distribution? . . . . . . . . . . 4 If you answered “No” to both questions 3 and 4, do not use this form.

5 a Did you use Form 4972 after 1986 for a previous distribution from your own plan? If “Yes,” do not use this form for a 2010 distribution from your own plan . . . . . . . . . . . . . . . . . . . . 5a

b If you are receiving this distribution as a beneficiary of a plan participant who died, did you use Form 4972 for a previous distribution received for that participant after 1986? If “Yes,” do not use the form for thisdistribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5b

Part II Complete this part to choose the 20% capital gain election (see instructions)6 Capital gain part from Form 1099-R, box 3 . . . . . . . . . . . . . . . . . . . 6 7 Multiply line 6 by 20% (.20) . . . . . . . . . . . . . . . . . . . . . . . ▶ 7

If you also choose to use Part III, go to line 8. Otherwise, include the amount from line 7 in the total on Form 1040, line 44, Form 1040NR, line 42, or Form 1041, Schedule G, line 1b, whichever applies. . .

Part III Complete this part to choose the 10-year tax option (see instructions)8 Ordinary income from Form 1099-R, box 2a minus box 3. If you did not complete Part II, enter the

taxable amount from Form 1099-R, box 2a . . . . . . . . . . . . . . . . . . . 8 9 Death benefit exclusion for a beneficiary of a plan participant who died before August 21, 1996 . 9

10 Total taxable amount. Subtract line 9 from line 8 . . . . . . . . . . . . . . . . . 10 11 Current actuarial value of annuity from Form 1099-R, box 8. If none, enter -0- . . . . . . . 11 12 Adjusted total taxable amount. Add lines 10 and 11. If this amount is $70,000 or more, skip lines

13 through 16, enter this amount on line 17, and go to line 18 . . . . . . . . . . . . 12 13 Multiply line 12 by 50% (.50), but do not enter more than $10,000 . . 13 14 Subtract $20,000 from line 12. If line 12 is

$20,000 or less, enter -0- . . . . . . 14 15 Multiply line 14 by 20% (.20) . . . . . . . . . . . . . . 15 16 Minimum distribution allowance. Subtract line 15 from line 13 . . . . . . . . . . . . 16 17 Subtract line 16 from line 12 . . . . . . . . . . . . . . . . . . . . . . . 17 18 Federal estate tax attributable to lump-sum distribution . . . . . . . . . . . . . . 18 19 Subtract line 18 from line 17. If line 11 is zero, skip lines 20 through 22 and go to line 23 . . . 19 20 Divide line 11 by line 12 and enter the result as a decimal (rounded to at

least three places) . . . . . . . . . . . . . . . . . . 20 21 Multiply line 16 by the decimal on line 20 . . . . . . . . . . 21 22 Subtract line 21 from line 11 . . . . . . . . . . . . . . 22 23 Multiply line 19 by 10% (.10) . . . . . . . . . . . . . . . . . . . . . . . 23 24 Tax on amount on line 23. Use the Tax Rate Schedule in the instructions . . . . . . . . . 24 25 Multiply line 24 by ten (10). If line 11 is zero, skip lines 26 through 28, enter this amount on

line 29, and go to line 30 . . . . . . . . . . . . . . . . . . . . . . . . 25 26 Multiply line 22 by 10% (.10) . . . . . . . . . . . . . . 26 27 Tax on amount on line 26. Use the Tax Rate Schedule in the

instructions . . . . . . . . . . . . . . . . . . . . 27 28 Multiply line 27 by ten (10) . . . . . . . . . . . . . . . . . . . . . . . . 28 29 Subtract line 28 from line 25. Multiple recipients, see instructions . . . . . . . . . . ▶ 29 30 Tax on lump-sum distribution. Add lines 7 and 29. Also include this amount in the total on Form

1040, line 44, Form 1040NR, line 42, or Form 1041, Schedule G, line 1b, whichever applies . . ▶ 30 For Paperwork Reduction Act Notice, see instructions. Cat. No. 13187U Form 4972 (2010)

OPTION METHOD

MULTIPLE RECIPIENTS CODE



Additional Taxes on Qualified Plans (Including IRAs) and Other Tax-Favored Accounts



OMB No. 1545-0074


Name of individual subject to additional tax. If married filing jointly, see instructions. Your social security number

Fill in Your Address Only If You Are Filing This Form by Itself and Not With Your Tax Return

▲ Home address (number and street), or P.O. box if mail is not delivered to your home Apt. no.

City, town or post office, state, and ZIP code If this is an amended return, check here ▶

If you only owe the additional 10% tax on early distributions, you may be able to report this tax directly on Form 1040, line 58, or Form 1040NR, line 56, without filing Form 5329. See the instructions for Form 1040, line 58, or for Form 1040NR, line 56.

Part I Additional Tax on Early DistributionsComplete this part if you took a taxable distribution before you reached age 59½ from a qualified retirement plan (including an IRA) or modified endowment contract (unless you are reporting this tax directly on Form 1040 or Form 1040NR—see above). You may also have to complete this part to indicate that you qualify for an exception to the additional tax on early distributions or for certain Roth IRA distributions (see instructions).

1 Early distributions included in income. For Roth IRA distributions, see instructions . . . . . . 1 2 Early distributions included on line 1 that are not subject to the additional tax (see instructions).

Enter the appropriate exception number from the instructions: . . . . . . . . . 2 3 Amount subject to additional tax. Subtract line 2 from line 1 . . . . . . . . . . . . . 3 4 Additional tax. Enter 10% (.10) of line 3. Include this amount on Form 1040, line 58, or Form

1040NR, line 56 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Caution: If any part of the amount on line 3 was a distribution from a SIMPLE IRA, you may have to include 25% of that amount on line 4 instead of 10% (see instructions).

Part II Additional Tax on Certain Distributions From Education AccountsComplete this part if you included an amount in income, on Form 1040 or Form 1040NR, line 21, from a Coverdelleducation savings account (ESA) or a qualified tuition program (QTP).

5 Distributions included in income from Coverdell ESAs and QTPs . . . . . . . . . . . . 5 6 Distributions included on line 5 that are not subject to the additional tax (see instructions) . . . 6 7 Amount subject to additional tax. Subtract line 6 from line 5 . . . . . . . . . . . . . 7 8 Additional tax. Enter 10% (.10) of line 7. Include this amount on Form 1040, line 58, or Form 1040NR, line 56 8

Part III Additional Tax on Excess Contributions to Traditional IRAsComplete this part if you contributed more to your traditional IRAs for 2010 than is allowable or you had an amount online 17 of your 2009 Form 5329.

9 Enter your excess contributions from line 16 of your 2009 Form 5329 (see instructions). If zero, go to line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 If your traditional IRA contributions for 2010 are less than your maximum allowable contribution, see instructions. Otherwise, enter -0- 10

11 2010 traditional IRA distributions included in income (see instructions) . 11 12 2010 distributions of prior year excess contributions (see instructions) . 12 13 Add lines 10, 11, and 12 . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Prior year excess contributions. Subtract line 13 from line 9. If zero or less, enter -0- . . . . . 14 15 Excess contributions for 2010 (see instructions) . . . . . . . . . . . . . . . . . 15 16 Total excess contributions. Add lines 14 and 15 . . . . . . . . . . . . . . . . . 16 17 Additional tax. Enter 6% (.06) of the smaller of line 16 or the value of your traditional IRAs on December 31, 2010

(including 2010 contributions made in 2011). Include this amount on Form 1040, line 58, or Form 1040NR, line 56 . 17 Part IV Additional Tax on Excess Contributions to Roth IRAs

Complete this part if you contributed more to your Roth IRAs for 2010 than is allowable or you had an amount on line 25 of your 2009 Form 5329.

18 Enter your excess contributions from line 24 of your 2009 Form 5329 (see instructions). If zero, go to line 23 18 19 If your Roth IRA contributions for 2010 are less than your maximum

allowable contribution, see instructions. Otherwise, enter -0- . . . . 19 20 2010 distributions from your Roth IRAs (see instructions) . . . . . 20 21 Add lines 19 and 20 . . . . . . . . . . . . . . . . . . . . . . . . . . 21 22 Prior year excess contributions. Subtract line 21 from line 18. If zero or less, enter -0- . . . . . 22 23 Excess contributions for 2010 (see instructions) . . . . . . . . . . . . . . . . . 23 24 Total excess contributions. Add lines 22 and 23 . . . . . . . . . . . . . . . . . 24 25 Additional tax. Enter 6% (.06) of the smaller of line 24 or the value of your Roth IRAs on December 31, 2010

(including 2010 contributions made in 2011). Include this amount on Form 1040, line 58, or Form 1040NR, line 56 . 25 For Privacy Act and Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 13329Q Form 5329 (2010)


Form 5329 (2010) Page 2 Part V Additional Tax on Excess Contributions to Coverdell ESAs

Complete this part if the contributions to your Coverdell ESAs for 2010 were more than is allowable or you had an amount on line 33 of your 2009 Form 5329.

26 Enter the excess contributions from line 32 of your 2009 Form 5329 (see instructions). If zero, go to line 31 26 27 If the contributions to your Coverdell ESAs for 2010 were less than the

maximum allowable contribution, see instructions. Otherwise, enter -0- 27 28 2010 distributions from your Coverdell ESAs (see instructions) . . . 28 29 Add lines 27 and 28 . . . . . . . . . . . . . . . . . . . . . . . . . . 29 30 Prior year excess contributions. Subtract line 29 from line 26. If zero or less, enter -0- . . . . . 30 31 Excess contributions for 2010 (see instructions) . . . . . . . . . . . . . . . . . 31 32 Total excess contributions. Add lines 30 and 31 . . . . . . . . . . . . . . . . . 32 33 Additional tax. Enter 6% (.06) of the smaller of line 32 or the value of your Coverdell ESAs on

December 31, 2010 (including 2010 contributions made in 2011). Include this amount on Form1040, line 58, or Form 1040NR, line 56 . . . . . . . . . . . . . . . . . . . . 33

Part VI Additional Tax on Excess Contributions to Archer MSAsComplete this part if you or your employer contributed more to your Archer MSAs for 2010 than is allowable or you had an amount on line 41 of your 2009 Form 5329.

34 Enter the excess contributions from line 40 of your 2009 Form 5329 (see instructions). If zero, go to line 39 34 35 If the contributions to your Archer MSAs for 2010 are less than the

maximum allowable contribution, see instructions. Otherwise, enter -0- 35 36 2010 distributions from your Archer MSAs from Form 8853, line 8 . . 36 37 Add lines 35 and 36 . . . . . . . . . . . . . . . . . . . . . . . . . . 37 38 Prior year excess contributions. Subtract line 37 from line 34. If zero or less, enter -0- . . . . . 38 39 Excess contributions for 2010 (see instructions) . . . . . . . . . . . . . . . . . 39 40 Total excess contributions. Add lines 38 and 39 . . . . . . . . . . . . . . . . . 40 41 Additional tax. Enter 6% (.06) of the smaller of line 40 or the value of your Archer MSAs on

December 31, 2010 (including 2010 contributions made in 2011). Include this amount on Form1040, line 58, or Form 1040NR, line 56 . . . . . . . . . . . . . . . . . . . . 41

Part VII Additional Tax on Excess Contributions to Health Savings Accounts (HSAs)Complete this part if you, someone on your behalf, or your employer contributed more to your HSAs for 2010 than is allowable or you had an amount on line 49 of your 2009 Form 5329.

42 Enter the excess contributions from line 48 of your 2009 Form 5329. If zero, go to line 47 . . . 42 43 If the contributions to your HSAs for 2010 are less than the maximum

allowable contribution, see instructions. Otherwise, enter -0- . . . . 43 44 2010 distributions from your HSAs from Form 8889, line 16 . . . . 44 45 Add lines 43 and 44 . . . . . . . . . . . . . . . . . . . . . . . . . . 45 46 Prior year excess contributions. Subtract line 45 from line 42. If zero or less, enter -0- . . . . . 46 47 Excess contributions for 2010 (see instructions) . . . . . . . . . . . . . . . . . 47 48 Total excess contributions. Add lines 46 and 47 . . . . . . . . . . . . . . . . . 48 49 Additional tax. Enter 6% (.06) of the smaller of line 48 or the value of your HSAs on December 31, 2010

(including 2010 contributions made in 2011). Include this amount on Form 1040, line 58, or Form 1040NR, line 56 49 Part VIII Additional Tax on Excess Accumulation in Qualified Retirement Plans (Including IRAs)

Complete this part if you did not receive the minimum required distribution from your qualified retirement plan.

50 Minimum required distribution for 2010 (see instructions) . . . . . . . . . . . . . . 50

51 Amount actually distributed to you in 2010 . . . . . . . . . . . . . . . . . . . 51 52 Subtract line 51 from line 50. If zero or less, enter -0- . . . . . . . . . . . . . . . 52 53 Additional tax. Enter 50% (.50) of line 52. Include this amount on Form 1040, line 58, or Form 1040NR, line 56 53

Sign Here Only If You Are Filing This Form by Itself and Not With Your Tax Return

Under penalties of perjury, I declare that I have examined this form, including accompanying attachments, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

▲

Your signature

▲

Date

Form 5329 (2010)



PTIN

Firm’s name ▶ Firm's EIN ▶

Firm's address ▶ Phone no.


Form 5405(Rev. December 2010)

Department of the Treasury Internal Revenue Service

First-Time Homebuyer Credit and Repayment of the Credit

▶ Attach to your 2009 or 2010 Form 1040, Form 1040NR, or Form 1040X. ▶ See separate instructions.

OMB No. 1545-0074


Note. Skip this page and complete page 2 if you are only filing this form to (1) report a disposition or change in use of your main home for which you claimed the credit in 2008 or 2009, or (2) pay an installment of the credit you claimed for a home purchased in 2008.


Part I General InformationA Address of home qualifying for the credit (if different from the address shown on page 1 of Form 1040 or Form 1040X)

B Date purchased (MM/DD/YYYY) (see instructions) . . . . . . . . . . . . . . . . . ▶

Note. If the date purchased is before May 1, 2010, go to line E. Otherwise, go to line C.C

If the date purchased is after April 30, 2010, and before October 1, 2010, did you enter into a binding contract before May 1, 2010, to purchase the home before July 1, 2010?

Yes. Go to line E. See instructions for documentation to be attached.No. You cannot claim the credit. However, if you (or your spouse if married) are a member of the uniformed services or Foreign Service, or an employee of the intelligence community, see line D. If line D applies, check the box on line D and continue; otherwise, you cannot claim the credit.

D If you meet the following conditions, check here . . . . . . . . . . . . . . . . . . . . . . . . ▶

I (or my spouse if married) was on qualified official extended duty outside the United States for at least 90 days during theperiod beginning after December 31, 2008, and ending before May 1, 2010, as a member of the uniformed services or ForeignService, or an employee of the intelligence community. If I purchased the home after April 30, 2011, and before July 1, 2011, I entered into a binding contract before May 1, 2011, to purchase the home before July 1, 2011. See instructions.

E Did you purchase the home from a related person or a person related to your spouse (see instructions)?No. Go to line F.Yes. You cannot claim the credit. Do not file Form 5405.

F

If you are choosing to claim the credit on your return for the year before the year in which you purchased the home, check here (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

Part II Credit1 Enter the purchase price of the new home (see instructions) . . . . . . . . . . . . . 1 2 Multiply line 1 by 10% (.10) and enter the result here . . . . . . . . . . . . . . . 2 3 If you qualify for the credit as (check the applicable box):

A first-time homebuyer, enter $8,000 ($4,000 if married filing separately). A first-time homebuyer is an individual (and that individual’s spouse if married) who has not owned another main home during the 3-year period ending on the purchase date and meets other requirements discussed in the instructions.

A long-time resident, enter $6,500 ($3,250 if married filing separately). A long-time resident is an individual (and that individual’s spouse if married) who has owned and used the same home as that individual’s main home for any 5-consecutive-year period during the 8-year period ending on the purchase date of the new main home and meets other requirements discussed in the instructions. See instructions for documentation to be attached.

} 3

4

Enter the smaller of line 2 or line 3. But: (a) if married filing separately, enter the smaller of line 3 or your share of the amount on line 2 (see instructions); or (b) if someone other than your spouse also purchased an interest in the home, enter the smaller of your share of the amount on line 3 or your share of the amount on line 2 (see instructions) . . . . . . . . . . . . . . . . . 4

5 Enter your modified adjusted gross income (see instructions) . . . . . . . . . . . . . 5 6 Enter $125,000 ($225,000 if married filing jointly) . . . . . . . . . . . . . . . . . 6 7 Is line 5 more than line 6?

No. Skip lines 7 and 8. Enter -0- on line 9 and go to line 10.Yes. Subtract line 6 from line 5 and enter the result. If the result is $20,000 or more, stop here.You cannot take the credit. Otherwise, go to line 8 . . . . . . . . . . . . . . . . 7

8 Divide line 7 by $20,000 and enter the result as a decimal (rounded to at least three places) . . 8 9 Multiply line 4 by line 8 . . . . . . . . . . . . . . . . . . . . . . . . . 9

10

Subtract line 9 from line 4 and enter the result. This is your credit. Also enter this amount on your 2009 or 2010 Form 1040, line 67, or the appropriate line in the “Payments” section of Form 1040X 10

▲!CAUTION

You must attach a copy of the properly executed settlement statement (or similar documentation) used to complete the purchase (see instructions).

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11880I Form 5405 (Rev. 12-2010)


Form 5405 (Rev. 12-2010) Page 2 Note. Skip this page if you are not filing this form to (1) report a disposition or change in use of your main home for which you claimed the credit in 2008 or 2009, or (2) pay an installment of the credit you claimed for a home purchased in 2008.


Part III Disposition or Change in Use of Main Home for Which the Credit Was Claimed11

Enter the date you disposed of, or ceased using as your main home, the home for which you claimed the credit (MM/DD/YYYY) (see instructions) . . . . . . . . . . . . . . . . . . . . . . ▶

12 If you meet the following conditions, check here . . . . . . . . . . . . . . . . . . . . . . . . ▶

I (or my spouse if married) am, or was, a member of the uniformed services or Foreign Service, or an employee of the intelligence community. I sold the home, or it ceased to be my main home, in connection with Government orders for qualified official extended duty service. No repayment of the credit is required (see instructions). Stop here.

13 Check the box below that applies to you. See the instructions for the definition of “related person.”a I sold (including through foreclosure) the home to a person who is not related to me and had a gain on the sale (as figured

using the worksheet in the instructions). Go to Part IV below.b I sold (including through foreclosure) the home to a person who is not related to me and did not have a gain on the sale (as

figured using the worksheet in the instructions). No repayment of the credit is required. Stop here.

c I sold the home to a related person. Go to Part IV below.d I converted the entire home to a rental or business use OR I still own the home but no longer use it as my main home. Go

to Part IV below.

e I transferred the home to my spouse (or ex-spouse as part of my divorce settlement). The full name of my ex-spouse is ▶

The responsibility for repayment of the credit is transferred to your spouse or ex-spouse. Stop here.f My home was destroyed, condemned, or disposed of under threat of condemnation and I acquired or plan to acquire a

new home within 2 years of the event (see instructions).g My home was destroyed, condemned, or disposed of under threat of condemnation and I do not plan to acquire a new

home within 2 years of the event (see instructions).h The taxpayer who claimed the credit died in 2010. No repayment of the credit is required of the deceased taxpayer. If you

are filing a joint return for 2010 with the deceased taxpayer, see instructions. Otherwise, stop here.

Part IV Repayment of Credit Claimed for 2008 or 200914

Enter the amount of the credit you claimed on Form 5405 for 2008 or 2009. See instructions if youfiled a joint return for the year you claimed the credit or sold your home under threat ofcondemnation. If you checked box 13a above, go to line 15. Otherwise, skip line 15 and go to line16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

15 Enter the gain on the sale of your main home (as figured using the worksheet in the instructions) . 15 16 Check the box below that applies to you. (Check only one box.)

a I am reporting a disposition or change in use of my main home. If you checked box 13a above, enter the smaller of line 14 or line 15. If you checked box 13g for an event that occurred before 2009, see instructions. Otherwise, enter the amount from line 14.

b I am paying an installment of the credit I claimed for a home purchased in 2008. Divide line 14 by 15.0 (but see instructions if you checked box 13g for an event that occurred after 2008). This is the minimum amount you must repay with your 2010 return. Enter this amount (or a larger amount if you choose) here. (see instructions) . . . . . . . . . . . . . . 16

Next: Include the amount from line 16 on your 2010 Form 1040, line 59, or Form 1040NR, line 58. Check the “Form 5405” box on that line.

Form 5405 (Rev. 12-2010)


Form 5695Department of the Treasury Internal Revenue Service

Residential Energy Credits▶ See instructions.


OMB No. 1545-0074



Part I Nonbusiness Energy Property Credit (See instructions before completing this part.)

1 Were the qualified energy efficiency improvements or residential energy property costs for your main home located in the United States? (see instructions) . . . . . . . . . . . ▶ 1 Yes No

Caution: If you checked the “No” box, you cannot claim the nonbusiness energy property credit. Do not complete Part I.

2 Qualified energy efficiency improvements (see instructions).a Insulation material or system specifically and primarily designed to reduce the heat loss or gain of

your home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a b Exterior windows (including certain storm windows) and skylights . . . . . . . . . . . 2bc Exterior doors (including certain storm doors) . . . . . . . . . . . . . . . . . . 2c d Metal roof with appropriate pigmented coatings or asphalt roof with appropriate cooling granules

that are specifically and primarily designed to reduce the heat gain of your home, and the roof meets or exceeds the Energy Star program requirements in effect at the time of purchase or installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d

3 Residential energy property costs (see instructions).a Energy-efficient building property . . . . . . . . . . . . . . . . . . . . . . 3a b Qualified natural gas, propane, or oil furnace or hot water boiler . . . . . . . . . . . . 3bc Advanced main air circulating fan used in a natural gas, propane, or oil furnace . . . . . . . 3c

4 Add lines 2a through 3c . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Multiply line 4 by 30% (.30) . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Maximum credit amount. (If you jointly occupied the home, see instructions) . . . . . . . . 6 $1,500

7 Enter the amount, if any, from your 2009 Form 5695, line 11. Otherwise enter -0- . . . . . . 7


9 Enter the smaller of line 5 or line 8 . . . . . . . . . . . . . . . . . . . . . 9

10 Limitation based on tax liability. Enter the amount from the Credit Limit Worksheet (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Nonbusiness energy property credit. Enter the smaller of line 9 or line 10. Also include thisamount on Form 1040, line 52, or Form 1040NR, line 49 . . . . . . . . . . . . . . 11

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 13540P Form 5695 (2010)

Official Use Only

Multiple home ind


Form 5695 (2010) Page 2

Part II Residential Energy Efficient Property Credit (See instructions before completing this part.)

Note. Skip lines 12 through 21 if you only have a credit carryforward from 2009.

12 Qualified solar electric property costs . . . . . . . . . . . . . . . . . . . . 12

13 Qualified solar water heating property costs . . . . . . . . . . . . . . . . . . 13

14 Qualified small wind energy property costs . . . . . . . . . . . . . . . . . . . 14

15 Qualified geothermal heat pump property costs . . . . . . . . . . . . . . . . . 15

16 Add lines 12 through 15 . . . . . . . . . . . . . . . . . . . . . . . . . 16

17 Multiply line 16 by 30% (.30) . . . . . . . . . . . . . . . . . . . . . . . 17

18 Qualified fuel cell property costs . . . . . . . . . . . . . 18

19 Multiply line 18 by 30% (.30) . . . . . . . . . . . . . . 19

20 Kilowatt capacity of property on line 18 above ▶ x $1,000 20

21 Enter the smaller of line 19 or line 20 . . . . . . . . . . . . . . . . . . . . . 21

22 Credit carryforward from 2009. Enter the amount, if any, from your 2009 Form 5695, line 28 . . 22

23 Add lines 17, 21, and 22 . . . . . . . . . . . . . . . . . . . . . . . . . 23

24 Enter the amount from Form 1040, line 46, or Form 1040NR, line 44 . 24

25 1040 filers: Enter the total, if any, of your credits from Form 1040, lines 47 through 50; line 11 of this form; line 12 of the Line 11 worksheet in Pub. 972 (see instructions); Form 8396, line 9; Form 8859, line 3; Form 8834, line 22; Form 8910, line 21; Form 8936, line 14; and Schedule R, line 22.

1040NR filers: Enter the amount, if any, from Form 1040NR, lines 45 through 47; line 11 of this form; line 12 of the Line 11 worksheet in Pub. 972 (see instructions); Form 8396, line 9; Form 8859, line 3; Form 8834, line 22; Form 8910, line 21; and Form 8936, line 14.

} 25

26 Subtract line 25 from line 24. If zero or less, enter -0- here and on line 27 . . . . . . . . . 26

27 Residential energy efficient property credit. Enter the smaller of line 23 or line 26. Also includethis amount on Form 1040, line 52, or Form 1040NR, line 49 . . . . . . . . . . . . . 27

28 Credit carryforward to 2011. If line 27 is less than line 23, subtract line 27 from line 23 . . . . . . . . . . . . . . . . . . . 28

Form 5695 (2010)

Official Use Only

CY Res Energy Cr


Version A, Cycle 1


Work Opportunity Credit

� Attach to your tax return.

OMB No. 1545-0219



1 Enter on the applicable line below the total qualified first- or second-year wages paid or incurred during the tax year, and multiply by the percentage shown, for services of employees who are certified (if required) as members of a targeted group.

a Qualified first-year wages of employees who worked for you at least 120 hours but fewer than 400 hours . . . . . $ � 25% (.25) 1a

b Qualified first-year wages of employees who worked for you at least 400 hours . . . . . . . . . . . . . . $ � 40% (.40) 1b

c Qualified second-year wages of employees certified as long-term family assistance recipients . . . . . . . $ � 50% (.50) 1c

2 Add lines 1a, 1b, and 1c. See instructions for the adjustment you must make to salaries and wages 2

3 Work opportunity credit from partnerships, S corporations, cooperatives, estates, and trusts . 3

4 Add lines 2 and 3. Partnerships and S corporations, report this amount on Schedule K; all others, go to line 5 . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Work opportunity credit included on line 4 from passive activities (see instructions) . . . . 5


7 Work opportunity credit allowed for 2010 from a passive activity (see instructions) . . . . . 7

8 Carryforward of any work opportunity credit that originated in a tax year that began after 2006 and carryforward from 2009 of the New York Liberty Zone business employee credit . . . . 8

9 Carryback of the work opportunity credit from 2011 (see instructions) . . . . . . . . . 9

10 Add lines 6 through 9. Cooperatives, estates, and trusts, continue on to line 11. All others, report this amount on Form 3800, line 29b . . . . . . . . . . . . . . . . . . . . 10

11 Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 Cooperatives, estates, and trusts, subtract line 11 from line 10. Report this amount on Form3800, line 29b . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.

What's New• The work opportunity credit is scheduled to expire for employees who begin work after August 31, 2011.

• The targeted groups for certain unemployed veterans and disconnected youth are scheduled to expire for employees who begin work after 2010.• The period for hiring a Hurricane Katrina employee is extended from a 4- to 5-year period beginning August 28, 2005.

• Qualified wages do not include first-year wages paid to or incurred for a qualified employee if you claim a social security

For Paperwork Reduction Act Notice, see instructions. Cat. No. 13570D Form 5884 (2010)

tax exemption for wages paid to the employee after March 18, 2010, and before January 1, 2011, on your Employer's Tax Return (Form 941, etc.).

Purpose of FormUse Form 5884 to claim the work opportunity credit for qualified first- or second-year wages you paid to or incurred for targeted group employees during the tax year. Your business does not have to be located in an empowerment zone, renewal community, or rural renewal county to qualify for this credit.

You can claim or elect not to claim the work opportunity credit any time within 3 years from the due date of your return on either your original return or an amended return.

Nondeductible Credit


Version A, Cycle 5

Form 5884-B(December 2010)


New Hire Retention Credit▶ Attach to your tax return.

▶ Use Part II to list additional retained workers.

OMB No. 1545-XXXX

Attachment Sequence No. 77B


A credit of up to $1,000 is allowed for each retained worker. A retained worker generally is a qualified employee (see instructions) whose first 52 consecutive weeks of employment ended in the current tax year. However, the worker's wages (as defined for income tax withholding purposes) for the second 26 consecutive weeks must equal at least 80% of the worker's wages for the first 26 consecutive weeks.

Part I New Hire Retention Credit for Retained Workers

Use a separate column for each retained worker. If you need more columns, use Part II and include the totals on line 10.

(a) Retained Worker No. 1

(b) Retained Worker No. 2

(c)

Retained Worker No. 3

1 Enter the retained worker's social security number . 1

2 Enter the first date of employment from the retained worker's Form W-11 or similar statement . . . . 2 / / 2010 / / 2010 / / 2010

3 Enter the retained worker's wages for the first 26 consecutive weeks of employment . . . . . . 3

4 Multiply line 3 by 80% (.80) . . . . . . . . . 45 Enter the retained worker's wages for the second 26

consecutive weeks of employment. If line 4 is larger than this amount, the qualified employee is not a retained worker and should not be listed on this form 5

6 Add lines 3 and 5 . . . . . . . . . . . . 6

7 Multiply line 6 by 6.2% (.062) . . . . . . . . 7

8 Maximum credit allowable . . . . . . . . . 8 1,000 00 1,000 00 1,000 00


10 Add columns (a) through (c) on line 9 above and columns (a) through (c) on lines 9 of any attached Parts II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Enter the total number of retained workers for whom you are receiving a credit on line 10 (see instructions) . . . . . . . . . . . . . 11

12 New hire retention credit from partnerships and S corporations (see instructions) . . . . . . 12

13 Current year credit. Add lines 10 and 12. Partnerships and S corporations, report this amount onSchedule K; all others, report this amount on the applicable line of Form 3800 (e.g., line 1aa of the2010 Form 3800) . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

For Paperwork Reduction Act Notice, see instructions. Cat. No. 55035V


Form 6198(Rev. November 2009)Department of the Treasury Internal Revenue Service

At-Risk Limitations� Attach to your tax return.

� See separate instructions.

OMB No. 1545-0712



Description of activity (see page 2 of the instructions)

Part I Current Year Profit (Loss) From the Activity, Including Prior Year Nondeductible Amounts. See page 2 of the instructions.

1 Ordinary income (loss) from the activity (see page 2 of the instructions) . . . . . . . . 1 2 Gain (loss) from the sale or other disposition of assets used in the activity (or of your interest in

the activity) that you are reporting on: . . . . . . . . . . . . . . . . . . .a Schedule D . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a b Form 4797 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2bc Other form or schedule . . . . . . . . . . . . . . . . . . . . . . . . 2c

3 Other income and gains from the activity, from Schedule K-1 of Form 1065, Form 1065-B, or Form 1120S, that were not included on lines 1 through 2c . . . . . . . . . . . . . 3

4 Other deductions and losses from the activity, including investment interest expense allowedfrom Form 4952, that were not included on lines 1 through 2c . . . . . . . . . . . 4 ( )

5 Current year profit (loss) from the activity. Combine lines 1 through 4. See page 3 of theinstructions before completing the rest of this form . . . . . . . . . . . . . . . 5

Part II Simplified Computation of Amount At Risk. See page 3 of the instructions before completing this part.6 Adjusted basis (as defined in section 1011) in the activity (or in your interest in the activity) on the

first day of the tax year. Do not enter less than zero . . . . . . . . . . . . . . . 6 7 Increases for the tax year (see page 3 of the instructions) . . . . . . . . . . . . . 7 8 Add lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . 8 9 Decreases for the tax year (see page 4 of the instructions) . . . . . . . . . . . . . 9

10a Subtract line 9 from line 8 . . . . . . . . . . . . � 10ab If line 10a is more than zero, enter that amount here and go to line 20 (or complete Part III).

Otherwise, enter -0- and see Pub. 925 for information on the recapture rules . . . . . . 10bPart III Detailed Computation of Amount At Risk. If you completed Part III of Form 6198 for the prior year, see

page 4 of the instructions.11 Investment in the activity (or in your interest in the activity) at the effective date. Do not enter

less than zero . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Increases at effective date . . . . . . . . . . . . . . . . . . . . . . . 12 13 Add lines 11 and 12 . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Decreases at effective date . . . . . . . . . . . . . . . . . . . . . . . 14 15 Amount at risk (check box that applies):

a At effective date. Subtract line 14 from line 13. Do not enter less than zero.b From your prior year Form 6198, line 19b. Do not enter the amount from line 10b of

your prior year form.� 15

16 Increases since (check box that applies):a Effective date b The end of your prior year . . . . . . . . . . . . . . 16

17 Add lines 15 and 16 . . . . . . . . . . . . . . . . . . . . . . . . . 17 18 Decreases since (check box that applies):

a Effective date b The end of your prior year . . . . . . . . . . . . . . 18 19a Subtract line 18 from line 17 . . . . . . . . . . . � 19a

b If line 19a is more than zero, enter that amount here and go to line 20. Otherwise, enter -0- and see Pub. 925 for information on the recapture rules . . . . . . . . . . . . . . . 19b

Part IV Deductible Loss20 Amount at risk. Enter the larger of line 10b or line 19b . . . . . . . . . . . . . 20 21 Deductible loss. Enter the smaller of the line 5 loss (treated as a positive number) or line 20.

See page 8 of the instructions to find out how to report any deductible loss and any carryover . 21 ( )

Note: If the loss is from a passive activity, see the Instructions for Form 8582, Passive Activity Loss Limitations, or the Instructions for Form 8810, Corporate Passive Activity Loss and Credit Limitations, to find out if the loss is allowed under the passive activity rules. If only part of the loss is subject to the passive activity loss rules, report only that part on Form 8582 or Form 8810, whichever applies.

For Paperwork Reduction Act Notice, see page 8 of the instructions. Cat. No. 50012Y Form 6198 (Rev. 11-2009)



Alternative Minimum Tax—Individuals▶ See separate instructions.


OMB No. 1545-0074


Name(s) shown on Form 1040 or Form 1040NR Your social security number

Part I Alternative Minimum Taxable Income (See instructions for how to complete each line.) 1

If filing Schedule A (Form 1040), enter the amount from Form 1040, line 41, and go to line 2. Otherwise, enter the amount from Form 1040, line 38, and go to line 6. (If less than zero, enter as a negative amount.) . . . . . 1

2

Medical and dental. Enter the smaller of Schedule A (Form 1040), line 4, or 2.5% (.025) of Form 1040, line 38. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Taxes from Schedule A (Form 1040), lines 5, 6, and 8 . . . . . . . . . . . . . . . . . . 3

4 Enter the home mortgage interest adjustment, if any, from line 6 of the worksheet on page 2 of the instructions 4

5 Miscellaneous deductions from Schedule A (Form 1040), line 27 . . . . . . . . . . . . . . . 5

6 If filing Schedule L (Form 1040A or 1040), enter as a negative amount the sum of lines 6 and 17 from that schedule 6 ( )

7 Tax refund from Form 1040, line 10 or line 21 . . . . . . . . . . . . . . . . . . . . 7 ( )

8 Investment interest expense (difference between regular tax and AMT) . . . . . . . . . . . . . 8

9 Depletion (difference between regular tax and AMT) . . . . . . . . . . . . . . . . . . 9

10 Net operating loss deduction from Form 1040, line 21. Enter as a positive amount . . . . . . . . . 10

11 Alternative tax net operating loss deduction . . . . . . . . . . . . . . . . . . . . . 11 ( )

12 Interest from specified private activity bonds exempt from the regular tax . . . . . . . . . . . . 12

13 Qualified small business stock (7% of gain excluded under section 1202) . . . . . . . . . . . . 13

14 Exercise of incentive stock options (excess of AMT income over regular tax income) . . . . . . . . . 14

15 Estates and trusts (amount from Schedule K-1 (Form 1041), box 12, code A) . . . . . . . . . . . 15

16 Electing large partnerships (amount from Schedule K-1 (Form 1065-B), box 6) . . . . . . . . . . . 16

17 Disposition of property (difference between AMT and regular tax gain or loss) . . . . . . . . . . . 17

18 Depreciation on assets placed in service after 1986 (difference between regular tax and AMT) . . . . . . 18

19 Passive activities (difference between AMT and regular tax income or loss) . . . . . . . . . . . 19

20 Loss limitations (difference between AMT and regular tax income or loss) . . . . . . . . . . . . 20

21 Circulation costs (difference between regular tax and AMT) . . . . . . . . . . . . . . . . 21

22 Long-term contracts (difference between AMT and regular tax income) . . . . . . . . . . . . . 22

23 Mining costs (difference between regular tax and AMT) . . . . . . . . . . . . . . . . . 23

24 Research and experimental costs (difference between regular tax and AMT) . . . . . . . . . . . 24

25 Income from certain installment sales before January 1, 1987. . . . . . . . . . . . . . . . 25 ( )

26 Intangible drilling costs preference . . . . . . . . . . . . . . . . . . . . . . . 26

27 Other adjustments, including income-based related adjustments . . . . . . . . . . . . . . 27

28

Alternative minimum taxable income. Combine lines 1 through 27. (If married filing separately and line 28 is more than $219,900, see page 8 of the instructions.) . . . . . . . . . . . . . . . . . . 28

Part II Alternative Minimum Tax (AMT) 29 Exemption. (If you were under age 24 at the end of 2010, see page 8 of the instructions.)

IF your filing status is . . . AND line 28 is not over . . . THEN enter on line 29 . . .

Single or head of household . . . . . $112,500 . . . . . . $47,450

Married filing jointly or qualifying widow(er) . 150,000 . . . . . . 72,450

Married filing separately . . . . . . . 75,000 . . . . . . 36,225 } . .

If line 28 is over the amount shown above for your filing status, see page 8 of the instructions.

29

30

Subtract line 29 from line 28. If more than zero, go to line 31. If zero or less, enter -0- here and on lines 33 and 35 and skip the rest of Part II . . . . . . . . . . . . . . . . . . . . . . . . . 30

31 • If you are filing Form 2555 or 2555-EZ, see page 9 of the instructions for the amount to enter. • If you reported capital gain distributions directly on Form 1040, line 13; you reported qualified dividends

on Form 1040, line 9b; or you had a gain on both lines 15 and 16 of Schedule D (Form 1040) (as refigured for the AMT, if necessary), complete Part III on the back and enter the amount from line 54 here.

• All others: If line 30 is $175,000 or less ($87,500 or less if married filing separately), multiply line 30 by 26% (.26). Otherwise, multiply line 30 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately) from the result.

} . . 31

32 Alternative minimum tax foreign tax credit (see page 9 of the instructions) . . . . . . . . . . . . 32

33 Tentative minimum tax. Subtract line 32 from line 31 . . . . . . . . . . . . . . . . . . 33

34

Tax from Form 1040, line 44 (minus any tax from Form 4972 and any foreign tax credit from Form 1040, line 47). If you used Schedule J to figure your tax, the amount from line 44 of Form 1040 must be refigured without using Schedule J (see page 11 of the instructions) . . . . . . . . . . . . . . . . 34

35 AMT. Subtract line 34 from line 33. If zero or less, enter -0-. Enter here and on Form 1040, line 45 . . . . . 35

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 13600G Form 6251 (2010)

KID

annualized return


Form 6251 (2010) Page 2

Part III Tax Computation Using Maximum Capital Gains Rates

36

Enter the amount from Form 6251, line 30. If you are filing Form 2555 or 2555-EZ, enter the amount from line 3 of the worksheet on page 9 of the instructions . . . . . . . . . . . . . . . . . . . . 36

37

Enter the amount from line 6 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44, or the amount from line 13 of the Schedule D Tax Worksheet in the instructions for Schedule D (Form 1040), whichever applies (as refigured for the AMT, if necessary) (see page 11 of the instructions). If you are filing Form 2555 or 2555-EZ, see page 11 of the instructions for the amount to enter . . . . . . . . . . . . . . 37

38

Enter the amount from Schedule D (Form 1040), line 19 (as refigured for the AMT, if necessary) (see page 11 of the instructions). If you are filing Form 2555 or 2555-EZ, see page 11 of the instructions for the amount to enter . . . . . . . . . 38

39

If you did not complete a Schedule D Tax Worksheet for the regular tax or the AMT, enter the amount from line 37. Otherwise, add lines 37 and 38, and enter the smaller of that result or the amount from line 10 of the Schedule D Tax Worksheet (as refigured for the AMT, if necessary). If you are filing Form 2555 or 2555-EZ, see page 11 of the instructions for the amount to enter . . . . . 39

40 Enter the smaller of line 36 or line 39 . . . . . . . . . . . . . . . . . . . . . . . 40

41 Subtract line 40 from line 36 . . . . . . . . . . . . . . . . . . . . . . . . . 41

42

If line 41 is $175,000 or less ($87,500 or less if married filing separately), multiply line 41 by 26% (.26). Otherwise, multiply line 41 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately) from the result . . . ▶ 42

43 Enter:

• $68,000 if married filing jointly or qualifying widow(er),

• $34,000 if single or married filing separately, or

• $45,550 if head of household. }. . . . 43

44

Enter the amount from line 7 of the Qualified Dividends and Capital Gain Tax Worksheet in the instructions for Form 1040, line 44, or the amount from line 14 of the Schedule D Tax Worksheet in the instructions for Schedule D (Form 1040), whichever applies (as figured for the regular tax). If you did not complete either worksheet for the regular tax, enter -0- . . . . . . . . . . . . . 44

45 Subtract line 44 from line 43. If zero or less, enter -0- . . . . . . . . . 45

46 Enter the smaller of line 36 or line 37 . . . . . . . . . . . . . 46

47 Enter the smaller of line 45 or line 46 . . . . . . . . . . . . . 47

48 Subtract line 47 from line 46 . . . . . . . . . . . . . . . . 48

49 Multiply line 48 by 15% (.15) . . . . . . . . . . . . . . . . . . . . . . . . ▶ 49

If line 38 is zero or blank, skip lines 50 and 51 and go to line 52. Otherwise, go to line 50.

50 Subtract line 46 from line 40 . . . . . . . . . . . . . . . . 50

51 Multiply line 50 by 25% (.25) . . . . . . . . . . . . . . . . . . . . . . . . ▶ 51

52 Add lines 42, 49, and 51 . . . . . . . . . . . . . . . . . . . . . . . . . . 52

53

If line 36 is $175,000 or less ($87,500 or less if married filing separately), multiply line 36 by 26% (.26). Otherwise, multiply line 36 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately) from the result . . . . 53

54

Enter the smaller of line 52 or line 53 here and on line 31. If you are filing Form 2555 or 2555-EZ, do not enter this amount on line 31. Instead, enter it on line 4 of the worksheet on page 9 of the instructions . . . . . 54

Form 6251 (2010)



Installment Sale Income▶ Attach to your tax return.

▶ Use a separate form for each sale or other disposition of

property on the installment method.

OMB No. 1545-0228



1 Description of property ▶ 2 a Date acquired (mm/dd/yyyy) ▶ b Date sold (mm/dd/yyyy) ▶

3 Was the property sold to a related party (see instructions) after May 14, 1980? If “No,” skip line 4 . . . . Yes No

4 Was the property you sold to a related party a marketable security? If “Yes,” complete Part III. If “No,” complete Part III for the year of sale and the 2 years after the year of sale . . . . . . . . . . . . Yes No

Part I Gross Profit and Contract Price. Complete this part for the year of sale only.5 Selling price including mortgages and other debts. Do not include interest, whether stated or unstated 5 6 Mortgages, debts, and other liabilities the buyer assumed or took the

property subject to (see instructions) . . . . . . . . . . . 6 7 Subtract line 6 from line 5. . . . . . . . . . . . . . . 7 8 Cost or other basis of property sold . . . . . . . . . . . 8 9 Depreciation allowed or allowable . . . . . . . . . . . . 9

10 Adjusted basis. Subtract line 9 from line 8 . . . . . . . . . 10 11 Commissions and other expenses of sale . . . . . . . . . 11 12 Income recapture from Form 4797, Part III (see instructions) . . . 12 13 Add lines 10, 11, and 12 . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Subtract line 13 from line 5. If zero or less, do not complete the rest of this form (see instructions) 14 15 If the property described on line 1 above was your main home, enter the amount of your excluded

gain (see instructions). Otherwise, enter -0- . . . . . . . . . . . . . . . . . . . 15 16 Gross profit. Subtract line 15 from line 14 . . . . . . . . . . . . . . . . . . . 16 17 Subtract line 13 from line 6. If zero or less, enter -0- . . . . . . . . . . . . . . . . 17 18 Contract price. Add line 7 and line 17 . . . . . . . . . . . . . . . . . . . . 18 Part II Installment Sale Income. Complete this part for the year of sale and any year you receive a payment or have

certain debts you must treat as a payment on installment obligations.19 Gross profit percentage (expressed as a decimal amount). Divide line 16 by line 18. For years after

the year of sale, see instructions . . . . . . . . . . . . . . . . . . . . . . 19 20 If this is the year of sale, enter the amount from line 17. Otherwise, enter -0- . . . . . . . . 20 21 Payments received during year (see instructions). Do not include interest, whether stated or unstated 21 22 Add lines 20 and 21 . . . . . . . . . . . . . . . . . . . . . . . . . . 22 23 Payments received in prior years (see instructions). Do not include

interest, whether stated or unstated . . . . . . . . . . . 23 Installment sale income. Multiply line 22 by line 19 . . . . . . . . . . . . . . . . 24

25 Enter the part of line 24 that is ordinary income under the recapture rules (see instructions) . . . 25 26 Subtract line 25 from line 24. Enter here and on Schedule D or Form 4797 (see instructions) . . . 26 Part III Related Party Installment Sale Income. Do not complete if you received the final payment this tax year.27 Name, address, and taxpayer identifying number of related party

28 Did the related party resell or dispose of the property (“second disposition”) during this tax year? . . . . . Yes No

29 If the answer to question 28 is “Yes,” complete lines 30 through 37 below unless one of the following conditions is met. Check the box that applies.a The second disposition was more than 2 years after the first disposition (other than dispositions of

marketable securities). If this box is checked, enter the date of disposition (mm/dd/yyyy) . . . . . ▶

b The first disposition was a sale or exchange of stock to the issuing corporation.c The second disposition was an involuntary conversion and the threat of conversion occurred after the first disposition.d The second disposition occurred after the death of the original seller or buyer.e It can be established to the satisfaction of the Internal Revenue Service that tax avoidance was not a principal purpose for

either of the dispositions. If this box is checked, attach an explanation (see instructions).

30 Selling price of property sold by related party (see instructions) . . . . . . . . . . . . 30 31 Enter contract price from line 18 for year of first sale . . . . . . . . . . . . . . . . 31 32 Enter the smaller of line 30 or line 31 . . . . . . . . . . . . . . . . . . . . . 32 33 Total payments received by the end of your 2010 tax year (see instructions) . . . . . . . . 33 Subtract line 33 from line 32. If zero or less, enter -0- . . . . . . . . . . . . . . . 35 Multiply line 34 by the gross profit percentage on line 19 for year of first sale . . . . . . . . 35 36 Enter the part of line 35 that is ordinary income under the recapture rules (see instructions) . . . 36 37 Subtract line 36 from line 35. Enter here and on Schedule D or Form 4797 (see instructions) . . . 37For Paperwork Reduction Act Notice, see page 4. Cat. No. 13601R Form 6252 (2010)

24

34

34



Gains and Losses From Section 1256 Contracts and Straddles

▶ Attach to your tax return.

OMB No. 1545-0644



Check all applicable boxes (see instructions). A Mixed straddle election

B Straddle-by-straddle identification election

C Mixed straddle account election

D Net section 1256 contracts loss election

Part I Section 1256 Contracts Marked to Market

(a) Identification of account (b) (Loss) (c) Gain

1

2 Add the amounts on line 1 in columns (b) and (c) . . . . . . . . . . . . 2 ( )

3 Net gain or (loss). Combine line 2, columns (b) and (c) . . . . . . . . . . . . . . . . . 3

4 Form 1099-B adjustments. See instructions and attach schedule . . . . . . . . . . . . . . 4

5 Combine lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Note: If line 5 shows a net gain, skip line 6 and enter the gain on line 7. Partnerships and S corporations, see instructions.

6 If you have a net section 1256 contracts loss and checked box D above, enter the amount of loss to be carried back. Enter the loss as a positive number . . . . . . . . . . . . . . . . . . 6

7 Combine lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 Short-term capital gain or (loss). Multiply line 7 by 40% (.40). Enter here and include on the appropriate line

of Schedule D (see instructions) . . . . . . . . . . . . . . . . . . . . . . . 8 9 Long-term capital gain or (loss). Multiply line 7 by 60% (.60). Enter here and include on the appropriate line

of Schedule D (see instructions) . . . . . . . . . . . . . . . . . . . . . . . 9 Part II Gains and Losses From Straddles. Attach a separate schedule listing each straddle and its components.

Section A—Losses From Straddles

(a) Description of property

(b) Date entered into or

acquired

(c) Date closed out

or sold


(e) Cost or other basis

plus expense of

sale

(f) Loss. If column (e) is more than

(d), enter difference. Otherwise, enter -0-

(g) Unrecognized

gain on offsetting positions

(h) Recognized loss. If column (f) is more

than (g), enter difference.

Otherwise, enter -0-

10

11a Enter the short-term portion of losses from line 10, column (h), here and include on the appropriate line of Schedule D (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 11a ( )

b Enter the long-term portion of losses from line 10, column (h), here and include on the appropriate line of Schedule D (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 11b ( )

Section B—Gains From Straddles



acquired

(c) Date closed out

or sold

(d) Gross

sales price

(e) Cost or other basis plus

expense of sale

(f) Gain. If column (d) is more than (e),

enter difference.


12

13a Enter the short-term portion of gains from line 12, column (f), here and include on the appropriate line of Schedule D (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 13a

b Enter the long-term portion of gains from line 12, column (f), here and include on the appropriate line of Schedule D (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 13b

Part III Unrecognized Gains From Positions Held on Last Day of Tax Year. Memo Entry Only (see instructions)

(a) Description of property (b) Date acquired

(c) Fair market value on last business day of tax year

(d) Cost or other basis as adjusted

(e) Unrecognized gain. If column (c) is more

than (d), enter difference. Otherwise, enter -0-

14

For Paperwork Reduction Act Notice, see page 4. Cat. No. 13715G Form 6781 (2010)


Form 8283 OMB No. 1545-0908

Noncash Charitable Contributions (Rev. December 2006) � Attach to your tax return if you claimed a total deduction

of over $500 for all contributed property.

AttachmentSequence No. 155

Department of the Treasury

� See separate instructions. Internal Revenue Service

Name(s) shown on your income tax return Identifying number

Note. Figure the amount of your contribution deduction before completing this form. See your tax return instructions. Section A. Donated Property of $5,000 or Less and Certain Publicly Traded Securities—List in this section only

items (or groups of similar items) for which you claimed a deduction of $5,000 or less. Also, list certainpublicly traded securities even if the deduction is more than $5,000 (see instructions). Information on Donated Property—If you need more space, attach a statement.

(b) Description of donated property(For a donated vehicle, enter the year, make, model, condition, and mileage,

and attach Form 1098-C if required.)

(a) Name and address of thedonee organization

1

D

Note. If the amount you claimed as a deduction for an item is $500 or less, you do not have to complete columns (d), (e), and (f). (h) Method used to determine

the fair market value

(f) Donor’s costor adjusted basis

(e) How acquiredby donor

(d) Date acquiredby donor (mo., yr.)

(c) Date of thecontribution

(g) Fair market value(see instructions)

A B

E Partial Interests and Restricted Use Property—Complete lines 2a through 2e if you gave less than anentire interest in a property listed in Part I. Complete lines 3a through 3c if conditions were placed on acontribution listed in Part I; also attach the required statement (see instructions). 2a

Total amount claimed as a deduction for the property listed in Part I:

b

c Name and address of each organization to which any such contribution was made in a prior year (complete only if differentfrom the donee organization above): Name of charitable organization (donee)

Address (number, street, and room or suite no.)

City or town, state, and ZIP code

For tangible property, enter the place where the property is located or kept � d Name of any person, other than the donee organization, having actual possession of the property � e

3a Yes No Is there a restriction, either temporary or permanent, on the donee’s right to use or dispose of the donatedproperty?

b

c

For Paperwork Reduction Act Notice, see separate instructions. Form 8283 (Rev. 12-2006)

C D

A

B

C

E

Part I

Part II

Enter the letter from Part I that identifies the property for which you gave less than an entire interest � .If Part II applies to more than one property, attach a separate statement.

Cat. No. 62299J

(1) (2)

For any prior tax years � .

For this tax year � .

Did you give to anyone (other than the donee organization or another organization participating with the doneeorganization in cooperative fundraising) the right to the income from the donated property or to the possession of the property, including the right to vote donated securities, to acquire the property by purchase or otherwise, orto designate the person having such income, possession, or right to acquire?

Is there a restriction limiting the donated property for a particular use?


Page 2 Form 8283 (Rev. 12-2006) Identifying number Name(s) shown on your income tax return

Section B. Donated Property Over $5,000 (Except Certain Publicly Traded Securities)—List in this section only items (or groups of similar items) for which you claimed a deduction of more than $5,000 per item or group (except contributions of certain publicly traded securities reported in Section A). An appraisal is generally required for property listed in Section B (see instructions). Information on Donated Property—To be completed by the taxpayer and/or the appraiser.

4 Check the box that describes the type of property donated:

Collectibles**

Qualified Conservation Contribution Other Real Estate

Securities

*Art includes paintings, sculptures, watercolors, prints, drawings, ceramics, antiques, decorative arts, textiles, carpets, silver, rare manuscripts, historical memorabilia, and other similar objects.

(c) Appraised fairmarket value

(b) If tangible property was donated, give a brief summary of the overallphysical condition of the property at the time of the gift

(a) Description of donated property (if you needmore space, attach a separate statement)

5

A

C D

See instructions (g) For bargain sales, enteramount received

(f) Donor’s cost or adjusted basis

(e) How acquired by donor

(d) Date acquired by donor (mo., yr.)

(i) Average trading price of securities

(h) Amount claimed as a deduction A

B C D

Taxpayer (Donor) Statement—List each item included in Part I above that the appraisal identifies as having a value of $500 or less. See instructions. I declare that the following item(s) included in Part I above has to the best of my knowledge and belief an appraised value of not more than $500

(per item). Enter identifying letter from Part I and describe the specific item. See instructions. �

Date � Signature of taxpayer (donor) �

Declaration of Appraiser I declare that I am not the donor, the donee, a party to the transaction in which the donor acquired the property, employed by, or related to any of the foregoing persons, or married to any person who is related to any of the foregoing persons. And, if regularly used by the donor, donee, or party to the transaction, I performed the majority of myappraisals during my tax year for other persons. Also, I declare that I hold myself out to the public as an appraiser or perform appraisals on a regular basis; and that because of my qualifications as described in theappraisal, I am qualified to make appraisals of the type of property being valued. I certify that the appraisal fees were not based on a percentage of the appraised property value. Furthermore, I understand that a false or fraudulent overstatement of the property value as described in the qualified appraisal or this Form 8283 may subject me to the penalty under section 6701(a) (aiding and abetting the understatement of tax liability). In addition, I understand that a substantial or gross valuation misstatementresulting from the appraisal of the value of the property that I know, or reasonably should know, would be used in connection with a return or claim for refund, may subject me to the penalty under section 6695A. I affirm that I have not been barred from presenting evidence or testimony by the Office of Professional Responsibility. SignHere

Signature � Date � Title �

Identifying number Business address (including room or suite no.)


Donee Acknowledgment—To be completed by the charitable organization. This charitable organization acknowledges that it is a qualified organization under section 170(c) and that it received the donated property as described in Section B, Part I, above on the following date �

Furthermore, this organization affirms that in the event it sells, exchanges, or otherwise disposes of the property described in Section B, Part I (or any portion thereof) within 3 years after the date of receipt, it will file Form 8282, Donee Information Return, with the IRS and give the donor a copy of that form. This acknowledgment does not represent agreement with the claimed fair market value.

Name of charitable organization (donee)

Address (number, street, and room or suite no.) City or town, state, and ZIP code

Authorized signature Title Date

B

Equipment

Part III

Part IV

Part I

Part II

Note. In certain cases, you must attach a qualified appraisal of the property. See instructions.

Does the organization intend to use the property for an unrelated use? �

Yes

No

Art* (contribution of less than $20,000)

Art* (contribution of $20,000 or more)

**Collectibles include coins, stamps, books, gems, jewelry, sports memorabilia, dolls, etc., but not art as defined above.

Intellectual Property

Other

Form 8283 (Rev. 12-2006)




Mortgage Interest Credit(For Holders of Qualified Mortgage Credit Certificates Issued by

State or Local Governmental Units or Agencies) ▶ Attach to Form 1040 or 1040NR. ▶ See instructions on back.

OMB No. 1545-0074


Name(s) shown on your tax return Your social security number

Enter the address of your main home to which the qualified mortgage certificate relates if it is different from the address shown on your tax return.

Name of Issuer of Mortgage Credit Certificate Mortgage Credit Certificate Number Issue Date

Before you begin Part I, figure the amounts of any of the following credits you are claiming: Credit for the elderly or the disabled, alternative motor vehicle credit, qualified plug-in electric vehicle credit, and qualified plug-in electric drive motor vehicle credit.

Part I Current Year Mortgage Interest Credit 1

Interest paid on the certified indebtedness amount. If someone else (other than your spouse if filing jointly) also held an interest in the home, enter only your share of the interest paid . . . 1

2

Enter the certificate credit rate shown on your mortgage credit certificate. Do not enter the interest rate on your home mortgage . . . . . . . . . . . . . . . . . . . . 2 %

3

If line 2 is 20% or less, multiply line 1 by line 2. If line 2 is more than 20%, or you refinanced your mortgage and received a reissued certificate, see the instructions for the amount to enter . 3 You must reduce your deduction for home mortgage interest on Schedule A (Form 1040)by the amount on line 3.

4 Enter any 2007 credit carryforward from line 18 of your 2009 Form 8396 . . . . . . . . 4




8

Limitation based on tax liability. Enter the amount from the Credit Limit Worksheet (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

9

Current year mortgage interest credit. Enter the smaller of line 7 or line 8. Also include this amount in the total on Form 1040, line 53, or Form 1040NR, line 50. Check box c on that line and enter "8396" in the space next to that box . . . . . . . . . . . . . . . . . . . 9

Part II Mortgage Interest Credit Carryforward to 2011. (Complete only if line 9 is less than line 7.)

10 Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Enter the amount from line 7. . . . . . . . . . . . . . . . . . . . . . . 11

12 Enter the larger of line 9 or line 10 . . . . . . . . . . . . . . . . . . . . . 12


14 2009 credit carryforward to 2011. Enter the smaller of line 6 or line 13 . . . . . . . . 14


16 2008 credit carryforward to 2011. Enter the smaller of line 5 or line 15 . . . . . . . . 16

17 2010 credit carryforward to 2011. Subtract line 9 from line 3. If zero or less, enter -0- . . . 17 For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 62502X Form 8396 (2010)



Passive Activity Loss Limitations

▶ See separate instructions. ▶ Attach to Form 1040 or Form 1041.

OMB No. 1545-1008



Part I 2010 Passive Activity LossCaution: Complete Worksheets 1, 2, and 3 on page 2 before completing Part I.

Rental Real Estate Activities With Active Participation (For the definition of active participation, see Special Allowance for Rental Real Estate Activities on page 3 of the instructions.)

1 a Activities with net income (enter the amount from Worksheet 1, column (a)) . . . . . . . . . . . . . . . . . . 1a

b Activities with net loss (enter the amount from Worksheet 1, column(b)) . . . . . . . . . . . . . . . . . . . . . 1b ( )

c Prior years unallowed losses (enter the amount from Worksheet 1, column (c)) . . . . . . . . . . . . . . . . . . 1c ( )

d Combine lines 1a, 1b, and 1c . . . . . . . . . . . . . . . . . . . . . . 1dCommercial Revitalization Deductions From Rental Real Estate Activities

2 a Commercial revitalization deductions from Worksheet 2, column (a) . 2a ( )

b Prior year unallowed commercial revitalization deductions from Worksheet 2, column (b) . . . . . . . . . . . . . . 2b ( )

c Add lines 2a and 2b . . . . . . . . . . . . . . . . . . . . . . . . . 2c ( )All Other Passive Activities

3 a Activities with net income (enter the amount from Worksheet 3, column (a)) . . . . . . . . . . . . . . . . . . 3a

b Activities with net loss (enter the amount from Worksheet 3, column(b)) . . . . . . . . . . . . . . . . . . . . . 3b ( )

c Prior years unallowed losses (enter the amount from Worksheet 3, column (c)) . . . . . . . . . . . . . . . . . . 3c ( )

d Combine lines 3a, 3b, and 3c . . . . . . . . . . . . . . . . . . . . . . 3d

4 Combine lines 1d, 2c, and 3d. If the result is net income or zero, all losses are allowed, including any prior year unallowed losses entered on line 1c, 2b, or 3c. Do not complete Form 8582. Report the losses on the forms and schedules normally used . . . . . . . . . . . . 4 If line 4 is a loss and: • Line 1d is a loss, go to Part II.

• Line 2c is a loss (and line 1d is zero or more), skip Part II and go to Part III. • Line 3d is a loss (and lines 1d and 2c are zero or more), skip Parts II and III and go to line 15.

Caution: If your filing status is married filing separately and you lived with your spouse at any time during the year, do not complete Part II or Part III. Instead, go to line 15.Part II Special Allowance for Rental Real Estate Activities With Active Participation

Note: Enter all numbers in Part II as positive amounts. See page 9 of the instructions for an example.5 Enter the smaller of the loss on line 1d or the loss on line 4 . . . . . . . . . . . . 5 6 Enter $150,000. If married filing separately, see page 9 . . . . 6 7 Enter modified adjusted gross income, but not less than zero (see page 9) 7

Note: If line 7 is greater than or equal to line 6, skip lines 8 and 9, enter -0- on line 10. Otherwise, go to line 8.

8 Subtract line 7 from line 6 . . . . . . . . . . . . . 8 9 Multiply line 8 by 50% (.5). Do not enter more than $25,000. If married filing separately, see page 9 9

10 Enter the smaller of line 5 or line 9 . . . . . . . . . . . . . . . . . . . . 10 If line 2c is a loss, go to Part III. Otherwise, go to line 15.

Part III Special Allowance for Commercial Revitalization Deductions From Rental Real Estate ActivitiesNote: Enter all numbers in Part III as positive amounts. See the example for Part II on page 9 of the instructions.

11 Enter $25,000 reduced by the amount, if any, on line 10. If married filing separately, see instructions 11 12 Enter the loss from line 4 . . . . . . . . . . . . . . . . . . . . . . . . 12 13 Reduce line 12 by the amount on line 10 . . . . . . . . . . . . . . . . . . 13 14 Enter the smallest of line 2c (treated as a positive amount), line 11, or line 13 . . . . . . 14 Part IV Total Losses Allowed15 Add the income, if any, on lines 1a and 3a and enter the total . . . . . . . . . . . . 15 16 Total losses allowed from all passive activities for 2010. Add lines 10, 14, and 15. See page 11 of

the instructions to find out how to report the losses on your tax return . . . . . . . . . . 16 For Paperwork Reduction Act Notice, see page 13 of the instructions. Cat. No. 63704F Form 8582 (2010)



Low-Income Housing Credit


OMB No. 1545-0984

2010Attachment Sequence No. 36a


Part I Buildings Placed in Service Before 20081

Number of Forms 8609-A attached for buildings placed in service before 2008 . . . . . . . . . . . . . . . . . . . . . . ▶

2

Has there been a decrease in the qualified basis of any buildings accounted for on line 1 since the close of the preceding tax year? Yes No If “Yes,” enter the buildingidentification numbers (BINs) of the buildings that had a decreased basis. If you need more space, attach a schedule.

(i) (ii) (iii) (iv)

3

Current year credit from attached Form(s) 8609-A for buildings placed in service before 2008 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4

Low-income housing credit for buildings placed in service before 2008 from partnerships, S corporations, estates, and trusts . . . . . . . . . . . . . . . . . . . . . 4

5

Add lines 3 and 4. Estates and trusts, go to line 6; partnerships and S corporations, report thisamount on Schedule K; all others, report this amount on Form 3800, line 1d . . . . . . . 5

6 Amount allocated to beneficiaries of the estate or trust (see instructions) . . . . . . . . 6

7 Estates and trusts. Subtract line 6 from line 5. Report this amount on Form 3800, line 1d . . 7Part II Buildings Placed in Service After 2007

8

Number of Forms 8609-A attached for buildings placed in service after 2007 . . . . . . . . . . . . . . . . . . . . . . ▶

9

Has there been a decrease in the qualified basis of any buildings accounted for on line 8 since the close of the preceding tax year? Yes No If “Yes,” enter the buildingidentification numbers (BINs) of the buildings that had a decreased basis. If you need more space, attach a schedule.

(i) (ii) (iii) (iv)

10

Current year credit from attached Form(s) 8609-A for buildings placed in service after 2007 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11

Low-income housing credit for buildings placed in service after 2007 from partnerships, S corporations, estates, and trusts. . . . . . . . . . . . . . . . . . . . . 11

12

Add lines 10 and 11. Partnerships and S corporations, report this amount on Schedule K; all others, continue to line 13 . . . . . . . . . . . . . . . . . . . . . . . 12

13 Low-income housing credit included on line 12 from passive activities (see instructions) . . . 13

14 Subtract line 13 from line 12 . . . . . . . . . . . . . . . . . . . . . . 14

15 Low-income housing credit allowed for 2010 from a passive activity (see instructions) . . . 15

16 Carryforward of low-income housing credit to 2010 (see instructions) . . . . . . . . . 16

17 Carryback of low-income housing credit from 2011 (see instructions) . . . . . . . . . 17 18

Add lines 14 through 17. Estates and trusts, go to line 19; all others, report this amount on Form 3800, line 29d . . . . . . . . . . . . . . . . . . . . . . . . . 18


20 Estates and trusts. Subtract line 19 from line 18. Report this amount on Form 3800, line 29d . 20For Paperwork Reduction Act Notice, see instructions. Cat. No. 63987I Form 8586 (2010)

Credit*Non Deductible



Nondeductible IRAs▶ See separate instructions.

▶ Attach to Form 1040, Form 1040A, or Form 1040NR.

OMB No. 1545-0074


Name. If married, file a separate form for each spouse required to file Form 8606. See instructions. Your social security number

Fill in Your Address Only If You Are Filing This Form by Itself and Not With Your Tax Return

▲

Home address (number and street, or P.O. box if mail is not delivered to your home) Apt. no.


Part I Nondeductible Contributions to Traditional IRAs and Distributions From Traditional, SEP, and SIMPLE IRAsComplete this part only if one or more of the following apply. • You made nondeductible contributions to a traditional IRA for 2010. • You took distributions from a traditional, SEP, or SIMPLE IRA in 2010 and you made nondeductible contributions to a

traditional IRA in 2010 or an earlier year. For this purpose, a distribution does not include a rollover, one-timedistribution to fund an HSA, conversion, recharacterization, or return of certain contributions.

• You converted part, but not all, of your traditional, SEP, and SIMPLE IRAs to Roth IRAs in 2010 (excluding any portionyou recharacterized) and you made nondeductible contributions to a traditional IRA in 2010 or an earlier year.

1

Enter your nondeductible contributions to traditional IRAs for 2010, including those made for 2010 from January 1, 2011, through April 18, 2011 (see instructions) . . . . . . . . . . . . 1

2 Enter your total basis in traditional IRAs (see instructions) . . . . . . . . . . . . . . 23 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

In 2010, did you take a distribution from traditional, SEP, or SIMPLE IRAs, or make a Roth IRA conversion?

No ▶ Enter the amount from line 3 on line 14. Do not complete the rest of Part I.

Yes ▶ Go to line 4.

4 Enter those contributions included on line 1 that were made from January 1, 2011, through April 18, 2011 . 45 Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . . . . . 56

Enter the value of all your traditional, SEP, and SIMPLE IRAs as of December 31, 2010, plus any outstanding rollovers (see instructions) . . 6

7

Enter your distributions from traditional, SEP, and SIMPLE IRAs in 2010. Do not include rollovers, a one-time distribution to fund an HSA, conversions to a Roth IRA, certain returned contributions, or recharacterizations of traditional IRA contributions (see instructions) . . 7

8

Enter the net amount you converted from traditional, SEP, and SIMPLE IRAs to Roth IRAs in 2010. Do not include amounts converted that you later recharacterized (see instructions). Also enter this amount on line 16 . 8

9 Add lines 6, 7, and 8 . . . . . . . . 910

Divide line 5 by line 9. Enter the result as a decimal rounded to at least 3 places. If the result is 1.000 or more, enter “1.000” . . . . . . 10 .

11

Multiply line 8 by line 10. This is the nontaxable portion of the amount you converted to Roth IRAs. Also enter this amount on line 17 . . . 11

12

Multiply line 7 by line 10. This is the nontaxable portion of your distributions that you did not convert to a Roth IRA . . . . . . . 12

13 Add lines 11 and 12. This is the nontaxable portion of all your distributions . . . . . . . . 1314 Subtract line 13 from line 3. This is your total basis in traditional IRAs for 2010 and earlier years 1415

Taxable amount. Subtract line 12 from line 7. If more than zero, also include this amount on Form1040, line 15b; Form 1040A, line 11b; or Form 1040NR, line 16b . . . . . . . . . . . . 15Note: You may be subject to an additional 10% tax on the amount on line 15 if you were under age 59½ at the time of the distribution (see instructions).

Part II 2010 Conversions From Traditional, SEP, or SIMPLE IRAs to Roth IRAsComplete this part if you converted part or all of your traditional, SEP, and SIMPLE IRAs to a Roth IRA in 2010 (excluding any portion you recharacterized).

16

If you completed Part I, enter the amount from line 8. Otherwise, enter the net amount you converted from traditional, SEP, and SIMPLE IRAs to Roth IRAs in 2010. Do not include amounts you later recharacterized back to traditional, SEP, or SIMPLE IRAs in 2010 or 2011 (see instructions) 16

17

If you completed Part I, enter the amount from line 11. Otherwise, enter your basis in the amount on line 16 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 17

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 63966F Form 8606 (2010)


Form 8606 (2010) Page 2 Part II 2010 Conversions From Traditional, SEP, or SIMPLE IRAs to Roth IRAs (Continued)18 Taxable amount. Subtract line 17 from line 16. . . . . . . . . . . . . . . . . . 18

19

Amount subject to tax in 2010. Check the box if you elect to report the entire taxableamount in 2010 rather than reporting 1/2 of it in 2011 and 1/2 in 2012. Generally, you must check this box if you check the box on line 24 (see instructions) . . . . . . . . . .If you checked the box, enter the amount from line 18 on this line and include this amount onForm 1040, line 15b, Form 1040A, line 11b, or Form 1040NR, line 16b.If you did not check the box, skip line 19 and go to line 20a. 19

20 a

Amount subject to tax in 2011. If you did not check the box on line 19, multiply the amount on line 18 by 50% (.50) and enter it here. Include this amount on the applicable line of your 2011 tax return . 20a

b

Amount subject to tax in 2012. Subtract line 20a from line 18. Include this amount on theapplicable line of your 2012 tax return . . . . . . . . . . . . . . . . . . . . 20b

Part III 2010 Rollovers From Qualified Retirement Plans to Roth IRAs and In-plan Rollovers to Designated Roth AccountsComplete this part if you rolled over part or all of your qualified retirement plan to a Roth IRA (excluding recharacterizations), or rolled over an amount to a designated Roth account within the same plan, in 2010.

21

Enter the amount you rolled over from qualified retirement plans to Roth IRAs and any in-plan rollovers to designated Roth accounts, in 2010. Do not include amounts you later recharacterizedto traditional IRAs in 2010 or 2011 (see instructions) . . . . . . . . . . . . . . . . 21

22 Enter your basis in the amount on line 21 . . . . . . . . . . . . . . . . . . . 2223 Taxable amount. Subtract line 22 from line 21. . . . . . . . . . . . . . . . . . 23

24

Amount subject to tax in 2010. Check the box if you elect to report the entire taxableamount in 2010 rather than reporting 1/2 of it in 2011 and 1/2 of it in 2012. Generally, youmust check this box if you checked the box on line 19 (see instructions) . . . . . . .If you checked the box, enter the amount from line 23 on this line and include this amount onForm 1040, line 16b, Form 1040A, line 12b, or Form 1040NR, line 17b . . . . . . . . . . 24If you did not check the box, skip line 24 and go to line 25a.

25 a

Amount subject to tax in 2011. If you did not check the box on line 24, multiply the amount on line 23 by 50% (.50) and enter it here. Include this amount on the applicable line of your 2011 tax return 25a

b

Amount subject to tax in 2012. Subtract line 25a from line 23. Include this amount on theapplicable line of your 2012 tax return . . . . . . . . . . . . . . . . . . 25b

Part IV Distributions From Roth IRAs (and Certain Distributions from Designated Roth Accounts (see instructions))Complete this part only if you took a distribution from a Roth IRA, and for certain distributions from a designated Rothaccount, in 2010. For this purpose, a distribution does not include a rollover, a one-time distribution to fund an HSA, recharacterization, or return of certain contributions (see instructions).

26

Enter your total nonqualified distributions from a Roth IRA in 2010, including any qualified first-time homebuyer distributions, and certain qualified distributions (see instructions) . . . . . . 26

27 Qualified first-time homebuyer distributions (see instructions). Do not enter more than $10,000 . 2728 Subtract line 27 from line 26. If zero or less, enter -0- and stop here. . . . . . . . . . . 2829 Enter your basis in Roth IRA contributions (see instructions) . . . . . . . . . . . . . 2930

Subtract line 29 from line 28. If zero or less, enter -0- and stop here. If the amount is more than zero, you may be subject to an additional tax (see instructions) . . . . . . . . . . . . 30

31

Enter your basis in conversions from traditional, SEP, and SIMPLE IRAs and rollovers from qualified retirement plans to a Roth IRA (see instructions) . . . . . . . . . . . . . . 31

32 Subtract line 31 from line 30. If zero or less, enter -0- and do not complete the rest of Part IV . . . 32Note. If you completed lines 20a and 20b, or 25a and 25b, go to line 33. Otherwise, enter the amount from line 32 on line 35 and go to line 36.

33 Enter the smaller of line 32 or the total of lines 20a, 20b, 25a, and 25b . . . 3334 Subtract line 33 from line 32. If zero, enter -0- and skip line 35 and go to line 36 3435 Subtract the total of lines 17 and 22 from line 34. If zero or less, enter -0- . . . . . . . . . . 3536

Taxable amount. Add lines 33 and 35. If more than zero, also include this amount on Form 1040, line 15b, Form 1040A, line 11b, or Form 1040NR, line 16b. For distributions from designated Roth accounts, see instructions . 36

Sign Here Only If You Are Filing This Form by Itself and Not With Your Tax Return

Under penalties of perjury, I declare that I have examined this form, including accompanying attachments, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

▲

Your signature

▲

Date



PTIN

Firm's name ▶

Firm's address ▶

Firm's EIN ▶

Phone no.

Form 8606 (2010)


Form

OMB No. 1545-0988 Annual Statement for Low-Income Housing Credit

� File with owner’s federal income tax return. (Rev. December 2008) Attachment Department of the Treasury

Internal Revenue Service

For Paperwork Reduction Act Notice, see separate instructions.


1 1 Eligible basis of building

. 2 2 Low-income portion (smaller of unit fraction or floor space fraction) (if first year of the credit

period, see instructions) 3 3 Qualified basis of low-income building. Multiply line 1 by line 2 (see instructions for exceptions)

4 Part-year adjustment for disposition or acquisition during the tax year

4 . 5 5 Credit percentage

6 Multiply line 3 or line 4 by the percentage on line 5

6 7 7 Additions to qualified basis, if any

8 8 9 . 9

10 10 Multiply line 7 or line 8 by the percentage on line 9 11 11 Section 42(f)(3)(B) modification

12 12 Add lines 10 and 11 13 13 Credit for building before line 14 reduction. Subtract line 12 from line 6

14 14 Disallowed credit due to federal grants (see instructions)

15 15 Credit allowed for building for tax year. Subtract line 14 from line 13, but do not enter more than

the amount shown on Form 8609, Part I, line 1b 16 Taxpayer’s proportionate share of credit for the year (see instructions)

16 17 18

Adjustments for deferred first-year credit (see instructions)

17 Taxpayer’s credit. Combine lines 16 and 17. Enter here and on Form 8586 (see instructions)

Sequence No. 36

Credit percentage. Enter one-third of the percentage on line 5

Cat No. 38841T

18 Form 8609-A (Rev. 12-2008)

Part-year adjustment for disposition or acquisition during the tax year

B

A

C

Building identification number (BIN) �

This Form 8609-A is for (check the box) � a newly constructed or existing building section 42(e) rehabilitation expenditures Do you have in your records the original Form 8609 (or a copy thereof) signed and issued by the housing creditagency for the building in A?

If “No,” see the instructions and stop here—do not go to Part II. Did the building in A qualify as a part of a qualified low-income housing project and meet the requirements ofsection 42 as of the end of the tax year for which this form is being filed?

If “No,” see the instructions and stop here—do not go to Part II. Was there a decrease in the qualified basis of the building in A for the tax year for which this form is beingfiled?

If “Yes,” see the instructions. If “No,” and the entire credit has been claimed in prior tax years, stop here—do not go to Part II.

D

E

Yes No Part I

Part II

Compliance Information

Computation of Credit

8609-A � See separate instructions.



Tax for Certain Children Who Have Investment Income of More Than $1,900

▶ Attach only to the child's Form 1040, Form 1040A, or Form 1040NR. ▶ See separate instructions.

OMB No. 1545-0074


Child’s name shown on return Child's social security number

Before you begin: If the child, the parent, or any of the parent’s other children for whom Form 8615 must be filed must use the Schedule D Tax Worksheet or has income from farming or fishing, see Pub. 929, Tax Rules for Children and Dependents. It explains how to figure the child’s tax using the Schedule D Tax Worksheet or Schedule J (Form 1040).

A Parent’s name (first, initial, and last). Caution: See instructions before completing. B Parent’s social security number

C Parent’s filing status (check one):

Single Married filing jointly Married filing separately Head of household Qualifying widow(er)

Part I Child’s Net Investment Income

1 Enter the child’s investment income (see instructions) . . . . . . . . . . . . . . . 1 2 If the child did not itemize deductions on Schedule A (Form 1040 or Form 1040NR), enter

$1,900. Otherwise, see instructions . . . . . . . . . . . . . . . . . . . . . 2 3 Subtract line 2 from line 1. If zero or less, stop; do not complete the rest of this form but do

attach it to the child’s return . . . . . . . . . . . . . . . . . . . . . . . 3 4 Enter the child’s taxable income from Form 1040, line 43; Form 1040A, line 27; or Form 1040NR,

line 41. If the child files Form 2555 or 2555-EZ, see the instructions . . . . . . . . . . 4 5 Enter the smaller of line 3 or line 4. If zero, stop; do not complete the rest of this form but do

attach it to the child’s return . . . . . . . . . . . . . . . . . . . . . . . 5 Part II Tentative Tax Based on the Tax Rate of the Parent

6 Enter the parent’s taxable income from Form 1040, line 43; Form 1040A, line 27; Form 1040EZ, line 6; Form 1040NR, line 41; or Form 1040NR-EZ, line 14. If zero or less, enter -0-. If the parent files Form 2555 or 2555-EZ, see the instructions . . . . . . . . . . . . . . . . . 6

7 Enter the total, if any, from Forms 8615, line 5, of all other children of the parent named above. Do not include the amount from line 5 above . . . . . . . . . . . . . . . . . . 7

8 Add lines 5, 6, and 7 (see instructions) . . . . . . . . . . . . . . . . . . . . 8

9 Enter the tax on the amount on line 8 based on the parent’s filing status above (see instructions). If the Qualified Dividends and Capital Gain Tax Worksheet, Schedule D Tax Worksheet, or Schedule J (Form 1040) is used to figure the tax, check here . . . . . . . . . ▶ 9

10 Enter the parent’s tax from Form 1040, line 44; Form 1040A, line 28, minus any alternative minimum tax; Form 1040EZ, line 11; Form 1040NR, line 42; or Form 1040NR-EZ, line 15. Do not include any tax from Form 4972 or 8814 or any tax from recapture of an education credit. If the parent files Form 2555 or 2555-EZ, see the instructions. If the Qualified Dividends and Capital Gain Tax Worksheet, Schedule D Tax Worksheet, or Schedule J (Form 1040) was used to figure the tax, check here . . . . . . . . . . . . . . . . . . . . . . ▶ 10

11 Subtract line 10 from line 9 and enter the result. If line 7 is blank, also enter this amount on line 13 and go to Part III . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12a Add lines 5 and 7 . . . . . . . . . . . . . . . . . . 12a b Divide line 5 by line 12a. Enter the result as a decimal (rounded to at least three places) . . . . 12b

13 Multiply line 11 by line 12b . . . . . . . . . . . . . . . . . . . . . . . . 13 Part III Child’s Tax—If lines 4 and 5 above are the same, enter -0- on line 15 and go to line 16.

14 Subtract line 5 from line 4 . . . . . . . . . . . . . . . 14

15 Enter the tax on the amount on line 14 based on the child’s filing status (see instructions). If the Qualified Dividends and Capital Gain Tax Worksheet, Schedule D Tax Worksheet, or Schedule J (Form 1040) is used to figure the tax, check here . . . . . . . . . ▶ 15

16 Add lines 13 and 15 . . . . . . . . . . . . . . . . . . . . . . . . . . 16

17 Enter the tax on the amount on line 4 based on the child’s filing status (see instructions). If the Qualified Dividends and Capital Gain Tax Worksheet, Schedule D Tax Worksheet, or Schedule J (Form 1040) is used to figure the tax, check here . . . . . . . . . ▶ 17

18 Enter the larger of line 16 or line 17 here and on the child’s Form 1040, line 44; Form 1040A, line 28; or Form 1040NR, line 42. If the child files Form 2555 or 2555-EZ, see the instructions 18

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 64113U Form 8615 (2010)


Version A, Cycle 1


Credit for Prior Year Minimum Tax— Individuals, Estates, and Trusts

▶ See separate instructions.▶ Attach to Form 1040, 1040NR, or 1041.

OMB No. 1545-1073



Part I Net Minimum Tax on Exclusion Items

1 Combine lines 1, 6, 7, and 11 of your 2009 Form 6251. Estates and trusts, see instructions . . . 1

2 Enter adjustments and preferences treated as exclusion items (see instructions) . . . . . . 2

3 Minimum tax credit net operating loss deduction (see instructions) . . . . . . . . . . . 3 ( )

4 Combine lines 1, 2, and 3. If zero or less, enter -0- here and on line 15 and go to Part II. If more than $216,900 and you were married filing separately for 2009, see instructions . . . . . . 4

5 Enter: $70,950 if married filing jointly or qualifying widow(er) for 2009; $46,700 if single or head of household for 2009; or $35,475 if married filing separately for 2009. Estates and trusts, enter $22,500 5

6 Enter: $150,000 if married filing jointly or qualifying widow(er) for 2009; $112,500 if single or head of household for 2009; or $75,000 if married filing separately for 2009. Estates and trusts, enter $75,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Subtract line 6 from line 4. If zero or less, enter -0- here and on line 8 and go to line 9 . . . . 7

8 Multiply line 7 by 25% (.25) . . . . . . . . . . . . . . . . . . . . . . . . 8

9 Subtract line 8 from line 5. If zero or less, enter -0-. If under age 24 at the end of 2009, see instructions 9

10 Subtract line 9 from line 4. If zero or less, enter -0- here and on line 15 and go to Part II. Form 1040NR filers, see instructions . . . . . . . . . . . . . . . . . . . . . . . 10

11 • If for 2009 you filed Form 2555 or 2555-EZ, see page 2 of the instructions for the amount to enter.

• If for 2009 you reported capital gain distributions directly on Form 1040, line 13; you reported qualified dividends on Form 1040, line 9b (Form 1041, line 2b(2)); or you had a gain on both lines 15 and 16 of Schedule D (Form 1040) (lines 14a and 15, column (2), of Schedule D (Form 1041)), complete Part III of Form 8801 and enter the amount from line47 here. Form 1040NR filers, see instructions.

• All others: If line 10 is $175,000 or less ($87,500 or less if married filing separately for 2009), multiply line 10 by 26% (.26). Otherwise, multiply line 10 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately for 2009) from the result. Form 1040NR filers, see instructions.

} 11

12 Minimum tax foreign tax credit on exclusion items (see instructions) . . . . . . . . . . 12

13 Tentative minimum tax on exclusion items. Subtract line 12 from line 11 . . . . . . . . . 13

14 Enter the amount from your 2009 Form 6251, line 35, or 2009 Form 1041, Schedule I, line 55 . .

15 Net minimum tax on exclusion items. Subtract line 14 from line 13. If zero or less, enter -0- . . 15 For Paperwork Reduction Act Notice, see page 4 of the instructions. Cat. No. 10002S Form 8801 (2010)

Pt. III indicator

Official Use Only

14


Version A, Cycle 1

Form 8801 (2010) Page 2 Part II Current Year Nonrefundable and Refundable Credits and Carryforward to 2011

16 Enter the amount from your 2009 Form 6251, line 36, or 2009 Form 1041, Schedule I, line 56 . . 16

17 Enter the amount from line 15 . . . . . . . . . . . . . . . . . . . . . . . 17

18 Subtract line 17 from line 16. If less than zero, enter as a negative amount . . . . . . . . 18

19 2009 credit carryforward. Enter the amount from your 2009 Form 8801, line 30 . . . . . . 19

20 Enter your 2009 unallowed qualified electric vehicle credit (see instructions) . . . . . . . . 20

21 Combine lines 18 through 20. If zero or less, stop here and see the instructions . . . . . . . 21

22 Enter your 2010 regular income tax liability minus allowable credits (see instructions) . . . . . 22

23 Enter the amount from your 2010 Form 6251, line 33, or 2010 Form 1041, Schedule I, line 54 . . . 23

24 Subtract line 23 from line 22. If zero or less, enter -0- . . . . . . . . . . . . . . . 24

25 Current year nonrefundable credit. Enter the smaller of line 21 or line 24. Also enter this amount on your 2010 Form 1040, line 53 (check box b); Form 1040NR, line 49 (check box b); or Form1041, Schedule G, line 2c . . . . . . . . . . . . . . . . . . . . . . . . 25

26 • Estates and trusts: Leave lines 26 and 27 blank and go to line 28. • Individuals: Did you have a minimum tax credit carryforward to 2008 (on your 2007 Form 8801, line 28)?

No. Leave lines 26 and 27 blank and go to line 28.

Yes. Complete Part IV of Form 8801 to figure the amount to enter . . . . . . . . . 26

27 Is line 26 more than line 25?

No. Leave line 27 blank and go to line 28.

Yes. Subtract line 25 from line 26. This is your current year refundable credit. Enter theresult here and on your 2010 Form 1040, line 71 (check box c), or Form 1040NR, line 66 (check box c) . . . . . . . . . . . . . . . . . . . . . . . . . 27

28 Credit carryforward to 2011. Subtract the larger of line 25 or line 26 from line 21. Keep a recordof this amount because you may use it in future years . . . . . . . . . . . . . . . 28

Form 8801 (2010)


Version A, Cycle 1

Form 8801 (2010) Page 3 Part III Tax Computation Using Maximum Capital Gains Rates

Caution. If you did not complete the 2009 Qualified Dividends and Capital Gain Tax Worksheet, the 2009 Schedule D Tax Worksheet, or Part V of the 2009 Schedule D (Form 1041), see theinstructions before completing this part.

29 Enter the amount from Form 8801, line 10. If you filed Form 2555 or 2555-EZ for 2009, enter theamount from line 3 of the worksheet on page 2 of the instructions . . . . . . . . . . . 29

Caution. If for 2009 you filed Form 1040NR, 1041, 2555, or 2555-EZ, see page 4 of theinstructions before completing lines 30, 31, and 32.

30 Enter the amount from line 6 of your 2009 Qualified Dividends and Capital Gain Tax Worksheet, the amount from line 13 of your 2009 Schedule D Tax Worksheet, or the amount from line 22 of the 2009 Schedule D (Form 1041), whichever applies* . . . . . . . . . 30 If you figured your 2009 tax using the 2009 Qualified Dividends and Capital Gain Tax Worksheet, skip line 31 and enter the amount from line 30 on line 32. Otherwise, go to line 31.

31 Enter the amount from line 19 of your 2009 Schedule D (Form 1040), or line 14b, column (2), of the 2009 Schedule D (Form 1041) . . . . . 31

32 Add lines 30 and 31, and enter the smaller of that result or the amount from line 10 of your 2009 Schedule D Tax Worksheet . . . . . . 32

33 Enter the smaller of line 29 or line 32 . . . . . . . . . . . . . . . . . . . . 33 34 Subtract line 33 from line 29 . . . . . . . . . . . . . . . . . . . . . . . 34 35 If line 34 is $175,000 or less ($87,500 or less if married filing separately for 2009), multiply line 34

by 26% (.26). Otherwise, multiply line 34 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately for 2009) from the result. Form 1040NR filers, see instructions . . . . . . . . ▶ 35

36 Enter: • $67,900 if married filing jointly or qualifying widow(er) for 2009, • $33,950 if single or married filing separately for 2009, • $45,500 if head of household for 2009, or • $2,300 for an estate or trust. Form 1040NR filers, see instructions . . . . . . . . . . . . 36

37 Enter the amount from line 7 of your 2009 Qualified Dividends and Capital Gain Tax Worksheet, the amount from line 14 of your 2009 Schedule D Tax Worksheet, or the amount from line 23 of the 2009 Schedule D (Form 1041), whichever applies. If you did not complete either worksheet or Part V of the 2009 Schedule D (Form 1041), enter -0-. Form 1040NR filers, see instructions . . . . . . . . . . 37

38 Subtract line 37 from line 36. If zero or less, enter -0- . . . . . . 38 39 Enter the smaller of line 29 or line 30 . . . . . . . . . . . 3940 Enter the smaller of line 38 or line 39 . . . . . . . . . . . 40 41 Subtract line 40 from line 39 . . . . . . . . . . . . . . 41 42 Multiply line 41 by 15% (.15) . . . . . . . . . . . . . . . . . . . . . . ▶ 42

If line 31 is zero or blank, skip lines 43 and 44 and go to line 45. Otherwise, go to line 43.

43 Subtract line 39 from line 33 . . . . . . . . . . . . . . 43 44 Multiply line 43 by 25% (.25) . . . . . . . . . . . . . . . . . . . . . . ▶ 44 45 Add lines 35, 42, and 44 . . . . . . . . . . . . . . . . . . . . . . . . . 45 46 If line 29 is $175,000 or less ($87,500 or less if married filing separately for 2009), multiply line 29

by 26% (.26). Otherwise, multiply line 29 by 28% (.28) and subtract $3,500 ($1,750 if married filing separately for 2009) from the result. Form 1040NR filers, see instructions . . . . . . . . . 46

47 Enter the smaller of line 45 or line 46 here and on line 11. If you filed Form 2555 or 2555-EZ for 2009, do not enter this amount on line 11. Instead, enter it on line 4 of the worksheet on page 2 ofthe instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

* The 2009 Qualified Dividends and Capital Gain Tax Worksheet is on page 38 of the 2009 Instructions for Form 1040. The 2009 Schedule D Tax Worksheet is on page D-10 of the 2009 Instructions for Schedule D (Form 1040) (page 8 of the 2009 Instructions for Schedule D (Form 1041)).

Form 8801 (2010)


Version A, Cycle 1

Form 8801 (2010) Page 4 Part IV Tentative Refundable Credit

48 Enter the amount from line 21 . . . . . . . . . . . . . . . . . . . . . . . 48

49 Enter the total of lines 18 and 20 from your 2008 Form 8801. If zero or less, enter -0- . . . . . . . . . . . . . . . . 49




53 Long-term unused minimum tax credit. Subtract line 52 from line 48 (If zero or less, enter -0- here and on line 26. Do not complete the rest of Part IV) . . . . . . . . . . . . . . 53

54 Multiply line 53 by 50% (.50) . . . . . . . . . . . . . . . . . . . . . . . 54

55 Enter the amount from your 2009 Form 8801, line 59. . . . . . . . . . . . . . . . 55

56 Enter the larger of line 54 or line 55 . . . . . . . . . . . . . . . . . . . . . 56

57 Enter the smaller of line 53 or line 56. Enter the result here and on line 26 . . . . . . . . 57Form 8801 (2010)

4 (*)

4

4

(*)

(*)



Additional Child Tax Credit

Complete and attach to Form 1040, Form 1040A, or Form 1040NR.

1040A . . . . . . . . . . 1040

8812

◀. . . . . . . . . .

1040NR

OMB No. 1545-0074


2010


Part I All Filers 1 1040 filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the

Instructions for Form 1040, line 51).1040A filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the

Instructions for Form 1040A, line 33).

1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worksheet (see the Instructions for Form 1040NR, line 48).

If you used Pub. 972, enter the amount from line 8 of the worksheet on page 4 of the publication.

} 1

2 Enter the amount from Form 1040, line 51, Form 1040A, line 33, or Form 1040NR, line 48 . . . . . . 2 3 Subtract line 2 from line 1. If zero, stop; you cannot take this credit . . . . . . . . . . . . . 3 4a Earned income (see instructions on back) . . . . . . . . . . . . 4a

b Nontaxable combat pay (see instructions on back) . . . . . . . . . . . . . 4b

5 Is the amount on line 4a more than $3,000? No. Leave line 5 blank and enter -0- on line 6. Yes. Subtract $3,000 from the amount on line 4a. Enter the result . . . 5

6 Multiply the amount on line 5 by 15% (.15) and enter the result . . . . . . . . . . . . . . 6 Next. Do you have three or more qualifying children?

No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part II and enter the smaller of line 3 or line 6 on line 13.

Yes. If line 6 is equal to or more than line 3, skip Part II and enter the amount from line 3 on line 13. Otherwise, go to line 7.

Part II Certain Filers Who Have Three or More Qualifying Children 7 Withheld social security and Medicare taxes from Form(s) W-2, boxes 4 and 6.

If married filing jointly, include your spouse’s amounts with yours. If you worked for a railroad, see instructions on back . . . . . . . . . . 7

8 1040 filers: Enter the total of the amounts from Form 1040, lines 27 and 57, plus any taxes that you identified using code “UT” and entered on the dotted line next to line 60.

1040A filers: Enter -0-.

1040NR filers: Enter the total of the amounts from Form 1040NR, lines 27 and 55, plus any taxes that you identified using code "UT" and entered on the dotted line next to line 59.

} 8

9 Add lines 7 and 8 . . . . . . . . . . . . . . . . . . . 9

10 1040 filers: Enter the total of the amounts from Form 1040, lines 64a and 69.

1040A filers: Enter the total of the amount from Form 1040A, line 41a, plus any excess social security and tier 1 RRTA taxes withheld that you entered to the left of line 44 (see instructions on back).

1040NR filers: Enter the amount from Form 1040NR, line 64.

} 10

11 Subtract line 10 from line 9. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 11 12 Enter the larger of line 6 or line 11 . . . . . . . . . . . . . . . . . . . . . . 12

Next, enter the smaller of line 3 or line 12 on line 13.

Part III Additional Child Tax Credit 13 This is your additional child tax credit . . . . . . . . . . . . . . . . . . . 13

. . . . . . . . . .

1040A 1040

. . . . . . . . . .

1040NR ◀

Enter this amount on Form 1040, line 65, Form 1040A, line 42, or Form 1040NR, line 62.

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 10644E Form 8812 (2010)



Parents' Election To Report Child's Interest and Dividends

▶ See instructions. ▶ Attach to parents' Form 1040 or Form 1040NR.

OMB No. 1545-0074


Name(s) shown on your return Your social security number

Caution. The federal income tax on your child’s income, including qualified dividends and capital gain distributions, may be less if you file a separate tax return for the child instead of making this election. This is because you cannot take certain tax benefits that your child could take on his or her own return. For details, see Tax benefits you cannot take on page 2.

A Child's name (first, initial, and last) B Child’s social security number

C If more than one Form 8814 is attached, check here . . . . . . . . . . . . . . . . . . . . ▶

Part I Child’s Interest and Dividends To Report on Your Return

1 a Enter your child’s taxable interest. If this amount is different from the amounts shown on the child’s Forms 1099-INT and 1099-OID, see the instructions . . . . . . . . . . . . 1a

b Enter your child’s tax-exempt interest. Do not include this amount on line 1a . . . . . . . . . . . . . . . . . . . 1b

2 a Enter your child’s ordinary dividends, including any Alaska Permanent Fund dividends. If your child received any ordinary dividends as a nominee, see the instructions . . . . . . . . 2a

b Enter your child’s qualified dividends included on line 2a. See the instructions . . . . . . . . . . . . . . . . . . 2b

3 Enter your child’s capital gain distributions. If your child received any capital gain distributions as a nominee, see the instructions . . . . . . . . . . . . . . . . . . . . 3

4 Add lines 1a, 2a, and 3. If the total is $1,900 or less, skip lines 5 through 12 and go to line 13. Ifthe total is $9,500 or more, do not file this form. Your child must file his or her own return to report the income . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Base amount . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1,900 00 6 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . 6

If both lines 2b and 3 are zero or blank, skip lines 7 through 10, enter -0- on line 11, and go to line 12. Otherwise, go to line 7.

7 Divide line 2b by line 4. Enter the result as a decimal (rounded to at least three places) . . . . . . . . . . . . . . . . 7

8 Divide line 3 by line 4. Enter the result as a decimal (rounded to at least three places) . . . . . . . . . . . . . . . . 8

9 Multiply line 6 by line 7. Enter the result here. See the instructions for where to report this amount on your return . . . . . . . 9

10 Multiply line 6 by line 8. Enter the result here. See the instructions for where to report this amount on your return . . . . . . . 10

11 Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Subtract line 11 from line 6. Include this amount in the total on Form 1040, line 21, or Form

1040NR, line 21. In the space next to line 21, enter “Form 8814” and show the amount. If you checked the box on line C above, see the instructions. Go to line 13 below . . . . . . . 12

Part II Tax on the First $1,900 of Child’s Interest and Dividends

13 Amount not taxed . . . . . . . . . . . . . . . . . . . . . . . . . . 13 950 00 14 Subtract line 13 from line 4. If the result is zero or less, enter -0- . . . . . . . . . . . 14 15 Tax. Is the amount on line 14 less than $950?

No. Enter $95 here and see the Note below. Yes. Multiply line 14 by 10% (.10). Enter the result here and see the Note below. } . . . 15

Note. If you checked the box on line C above, see the instructions. Otherwise, include the amount from line 15 in the tax you enter on Form 1040, line 44, or Form 1040NR, line 42. Be sure to check box a on Form 1040, line 44, or Form 1040NR, line 42. For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 10750J Form 8814 (2010)

if additional form, net income if additional form, tax



Like-Kind Exchanges (and section 1043 conflict-of-interest sales)


OMB No. 1545-1190



Part I Information on the Like-Kind Exchange

Note: If the property described on line 1 or line 2 is real or personal property located outside the United States, indicate the country.

1 Description of like-kind property given up:

2 Description of like-kind property received:

3 Date like-kind property given up was originally acquired (month, day, year) . . . . . . 3 MM/DD/YYYY

4 Date you actually transferred your property to other party (month, day, year) . . . . . 4 MM/DD/YYYY

5 Date like-kind property you received was identified by written notice to another party (month, day, year). See instructions for 45-day written identification requirement . . . . . . . 5 MM/DD/YYYY

6 Date you actually received the like-kind property from other party (month, day, year). See instructions 6 MM/DD/YYYY

7 Was the exchange of the property given up or received made with a related party, either directly or indirectly (such as through an intermediary)? See instructions. If “Yes,” complete Part II. If “No,” go to Part III . . . Yes No

Part II Related Party Exchange Information8 Name of related party Relationship to you Related party’s identifying number

Address (no., street, and apt., room, or suite no., city or town, state, and ZIP code)

9 During this tax year (and before the date that is 2 years after the last transfer of property that was part of the exchange), did the related party sell or dispose of any part of the like-kind property received from you (or an intermediary) in the exchange or transfer property into the exchange, directly or indirectly (such as through an intermediary), that became your replacement property? . . . . . . . . . . . . . . Yes No

10 During this tax year (and before the date that is 2 years after the last transfer of property that was part of the exchange), did you sell or dispose of any part of the like-kind property you received? . . . . . . Yes No

If both lines 9 and 10 are “No” and this is the year of the exchange, go to Part III. If both lines 9 and 10 are “No” and this is not the year of the exchange, stop here. If either line 9 or line 10 is “Yes,” complete Part III and report on this year’s tax return the deferred gain or (loss) from line 24 unless one of the exceptions on line 11 applies.

11 If one of the exceptions below applies to the disposition, check the applicable box:

a The disposition was after the death of either of the related parties.

b The disposition was an involuntary conversion, and the threat of conversion occurred after the exchange.

c You can establish to the satisfaction of the IRS that neither the exchange nor the disposition had tax avoidance as one of its principal purposes. If this box is checked, attach an explanation (see instructions).

For Paperwork Reduction Act Notice, see page 4 of the instructions. Cat. No. 12311A Form 8824 (2010)


Form 8824 (2010) Page 2Name(s) shown on tax return. Do not enter name and social security number if shown on other side. Your social security number

Part III Realized Gain or (Loss), Recognized Gain, and Basis of Like-Kind Property ReceivedCaution: If you transferred and received (a) more than one group of like-kind properties or (b) cash or other (not like-kind) property, see Reporting of multi-asset exchanges in the instructions.Note: Complete lines 12 through 14 only if you gave up property that was not like-kind. Otherwise, go to line 15.

12 Fair market value (FMV) of other property given up . . . . . 12 13 Adjusted basis of other property given up . . . . . . . . 13 14 Gain or (loss) recognized on other property given up. Subtract line 13 from line 12. Report the

gain or (loss) in the same manner as if the exchange had been a sale . . . . . . . . . 14 Caution: If the property given up was used previously or partly as a home, see Property used as home in the instructions.

15 Cash received, FMV of other property received, plus net liabilities assumed by other party, reduced (but not below zero) by any exchange expenses you incurred (see instructions) . . 15

16 FMV of like-kind property you received . . . . . . . . . . . . . . . . . . . 16 17 Add lines 15 and 16 . . . . . . . . . . . . . . . . . . . . . . . . . 17 18 Adjusted basis of like-kind property you gave up, net amounts paid to other party, plus any

exchange expenses not used on line 15 (see instructions) . . . . . . . . . . . . . 18 19 Realized gain or (loss). Subtract line 18 from line 17 . . . . . . . . . . . . . . 19 20 Enter the smaller of line 15 or line 19, but not less than zero . . . . . . . . . . . . 20 21 Ordinary income under recapture rules. Enter here and on Form 4797, line 16 (see instructions) 21 22 Subtract line 21 from line 20. If zero or less, enter -0-. If more than zero, enter here and on

Schedule D or Form 4797, unless the installment method applies (see instructions) . . . . 22 23 Recognized gain. Add lines 21 and 22 . . . . . . . . . . . . . . . . . . . 23 24 Deferred gain or (loss). Subtract line 23 from line 19. If a related party exchange, see instructions . 24 25 Basis of like-kind property received. Subtract line 15 from the sum of lines 18 and 23 . . 25 Part IV Deferral of Gain From Section 1043 Conflict-of-Interest Sales

Note: This part is to be used only by officers or employees of the executive branch of the Federal Government or judicial officers of the Federal Government (including certain spouses, minor or dependent children, and trustees as described in section 1043) for reporting nonrecognition of gain under section 1043 on the sale of property to comply with the conflict-of-interest requirements. This part can be used only if the cost of the replacement property is more than the basis of the divested property.

26 Enter the number from the upper right corner of your certificate of divestiture. (Do not attach a copy of your certificate. Keep the certificate with your records.) . . . . . . . . . . ▶ –

27 Description of divested property ▶

28 Description of replacement property ▶

29 Date divested property was sold (month, day, year) . . . . . . . . . . . . . . . 29 MM/DD/YYYY

30 Sales price of divested property (see instructions). . . . . . 30

31 Basis of divested property . . . . . . . . . . . . . 31

32 Realized gain. Subtract line 31 from line 30 . . . . . . . . . . . . . . . . . 32 33 Cost of replacement property purchased within 60 days after date

of sale . . . . . . . . . . . . . . . . . . . . 33


35 Ordinary income under recapture rules. Enter here and on Form 4797, line 10 (see instructions) 35 36 Subtract line 35 from line 34. If zero or less, enter -0-. If more than zero, enter here and on

Schedule D or Form 4797 (see instructions) . . . . . . . . . . . . . . . . . 36

37 Deferred gain. Subtract the sum of lines 35 and 36 from line 32 . . . . . . . . . . 37

38 Basis of replacement property. Subtract line 37 from line 33 . . . . . . . . . . . 38 Form 8824 (2010)



Expenses for Business Use of Your Home▶ File only with Schedule C (Form 1040). Use a separate Form 8829 for each

home you used for business during the year.▶ See separate instructions.

OMB No. 1545-0074


Name(s) of proprietor(s) Your social security number

Part I Part of Your Home Used for Business 1 Area used regularly and exclusively for business, regularly for daycare, or for storage of

inventory or product samples (see instructions) . . . . . . . . . . . . . . . . 1 2 Total area of home . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Divide line 1 by line 2. Enter the result as a percentage. . . . . . . . . . . . . . 3

For daycare facilities not used exclusively for business, go to line 4. All others go to line 7. %

4 Multiply days used for daycare during year by hours used per day 4 hr.5 Total hours available for use during the year (365 days x 24 hours) (see instructions) 5 8,760 hr. 6 Divide line 4 by line 5. Enter the result as a decimal amount . . . 6 7 Business percentage. For daycare facilities not used exclusively for business, multiply line 6 by

line 3 (enter the result as a percentage). All others, enter the amount from line 3 . . . . . ▶ 7 % Part II Figure Your Allowable Deduction 8 Enter the amount from Schedule C, line 29, plus any net gain or (loss) derived from the business use of your home

and shown on Schedule D or Form 4797. If more than one place of business, see instructions . . . . . . . 8 See instructions for columns (a) and (b) before completing lines 9–21.

(a) Direct expenses (b) Indirect expenses

9 Casualty losses (see instructions) . . . . . 9 10 Deductible mortgage interest (see instructions) 10 11 Real estate taxes (see instructions) . . . . 11 12 Add lines 9, 10, and 11 . . . . . . . . 12 13 Multiply line 12, column (b) by line 7 . . . . 13

Add line 12, column (a) and line 13 . . . . 14 15 Subtract line 14 from line 8. If zero or less, enter -0- 15 16 Excess mortgage interest (see instructions) . 16 17 Insurance . . . . . . . . . . . . 17 18 Rent . . . . . . . . . . . . . . 18 19 Repairs and maintenance . . . . . . . 19 20 Utilities . . . . . . . . . . . . . 20 21 Other expenses (see instructions). . . . . 21 22 Add lines 16 through 21 . . . . . . . . 22 23 Multiply line 22, column (b) by line 7 . . . . . . . . . . . 23 24 Carryover of operating expenses from 2009 Form 8829, line 42 . . 24 25 Add line 22 column (a), line 23, and line 24. . . . . . . . . . . . . . . . . . 25 26 Allowable operating expenses. Enter the smaller of line 15 or line 25 . . . . . . . . . 26 27 Limit on excess casualty losses and depreciation. Subtract line 26 from line 15 . . . . . 27 28 Excess casualty losses (see instructions) . . . . . . . . . 28 29 Depreciation of your home from line 41 below . . . . . . . 29 30 Carryover of excess casualty losses and depreciation from 2009 Form 8829, line 43 30 31 Add lines 28 through 30 . . . . . . . . . . . . . . . . . . . . . . . . 31 32 Allowable excess casualty losses and depreciation. Enter the smaller of line 27 or line 31 . . 32 33 Add lines 14, 26, and 32. . . . . . . . . . . . . . . . . . . . . . . . 33 34 Casualty loss portion, if any, from lines 14 and 32. Carry amount to Form 4684 (see instructions) 34 35 Allowable expenses for business use of your home. Subtract line 34 from line 33. Enter here

and on Schedule C, line 30. If your home was used for more than one business, see instructions ▶ 35 Part III Depreciation of Your Home 36 Enter the smaller of your home’s adjusted basis or its fair market value (see instructions) . . 36 37 Value of land included on line 36 . . . . . . . . . . . . . . . . . . . . . 37 38 Basis of building. Subtract line 37 from line 36 . . . . . . . . . . . . . . . . 38 39 Business basis of building. Multiply line 38 by line 7. . . . . . . . . . . . . . . 39 40 Depreciation percentage (see instructions). . . . . . . . . . . . . . . . . . 40 % 41 Depreciation allowable (see instructions). Multiply line 39 by line 40. Enter here and on line 29 above 41 Part IV Carryover of Unallowed Expenses to 201142 Operating expenses. Subtract line 26 from line 25. If less than zero, enter -0- . . . . . . 42 43 Excess casualty losses and depreciation. Subtract line 32 from line 31. If less than zero, enter -0- 43

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 13232M Form 8829 (2010)

14



Qualified Plug-in Electric and Electric Vehicle Credit


OMB No. 1545-1374



Note.• Use this form to claim the credit for certain two- or three-wheeled vehicles or low-speed four-wheeled plug-in electric vehicles.• Claim the credit for certain other plug-in electric vehicles on Form 8936.• Claim the credit for certain alternative motor vehicles or plug-in electric vehicle conversions on Form 8910.Part I Qualified Plug-in Electric Vehicle Credit

Section A—Vehicle InformationUse a separate column for each vehicle. If you need more columns, use additional Forms 8834 and include the totals on lines 11 and 18.

(a) Vehicle 1

(b) Vehicle 2

(c) Vehicle 3

1 Year, make, and model of vehicle . . . . . . . . . 12 Enter date vehicle was placed in service (MM/DD/YYYY) . 2 / / / / / / 3 Cost of the vehicle . . . . . . . . . . . . . . 3

Next: If you did NOT use your vehicle for business or investment purposes and did not have a credit from a partnership or S corporation, skip Section B and go to Section C. All others, go to Section B.

Section B—Credit for Business/Investment Use Part of Vehicle

4 Business/investment use percentage (see instructions) . . 4 % % %5 Multiply line 3 by line 4 . . . . . . . . . . . . 56 Section 179 expense deduction (see instructions) . . . 6 7 Subtract line 6 from line 5 . . . . . . . . . . . 7 8 Multiply line 7 by 10% (.10) . . . . . . . . . . . 8 9 Maximum credit per vehicle . . . . . . . . . . . 9

10 Enter the smaller of line 8 or line 9 . . . . . . . . 1011 Add columns (a) through (c) on line 10 . . . . . . . . . . . . . . . . . . . . 1112 Qualified plug-in electric vehicle credit from partnerships and S corporations . . . . . . . 1213 Business/investment use part of credit. Add lines 11 and 12. Partnerships and S corporations,

report this amount on Schedule K; all others, report this amount on Form 3800, line 1z . . . . 13Section C—Credit for Personal Use Part of Vehicle

(a) Vehicle 1

(b) Vehicle 2

(c) Vehicle 3

14

If you skipped Section B, enter the amount from line 3. If you completed Section B, subtract line 5 from line 3 . . . . 14

15 Multiply line 14 by 10% (.10) . . . . . . . . . . 1516

Maximum credit per vehicle. If you skipped Section B, enter $2,500. If you completed Section B, subtract line 10 from line 9 . . . . . . . . . . . . . . . . . . 16

17 Enter the smaller of line 15 or line 16 . . . . . . . 1718 Add columns (a) through (c) on line 17 . . . . . . . . . . . . . . . . . . . . 1819 Enter the amount from Form 1040, line 46, or Form 1040NR, line 44 . . . . . . . . . . 1920 Personal credits from Form 1040 or 1040NR (see instructions) . . . . . . . . . . . . 2021 Subtract line 20 from line 19. If zero or less, stop. You cannot claim the personal use part of the

credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

22 Personal use part of credit. Enter the smaller of line 18 or line 21. Report the total of this amount and the amount, if any, from line 29 on Form 1040, line 53 (or Form 1040NR, line 50). Check box c on that line and enter “8834” in the space next to that box. If line 21 is smaller than line 18, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

For Paperwork Reduction Act Notice, see instructions. Cat. No. 14953G Form 8834 (2010)


Form 8834 (2010) Page 2Part II Qualified Electric Vehicle Credit

Caution. This part only applies to qualified electric vehicle passive activity credits from prior years (allowed on Form 8582-CR or Form 8810).

23 Qualified electric vehicle passive activity credits allowed for 2010 (see instructions) . . . . . 23

24 Regular tax before credits:• Individuals. Enter the amount from Form 1040, line 44, or Form 1040NR, line 42.• Corporations. Enter the amount from Form 1120, Schedule J, line 2; or the

applicable line of your return.• Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G,

lines 1a and 1b, or the amount from the applicable line of your return.} . . . . 24

25 Credits that reduce regular tax before the qualified electric vehicle credit:a Foreign tax credit . . . . . . . . . . . . . . . . . . 25ab Personal credits from Form 1040 or 1040NR (see instructions) . . . 25bc American Samoa economic development credit (Form 5735) . . . . 25cd Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . . . 25d

26 Net regular tax. Subtract line 25d from line 24. If zero or less, stop here; do not file this formunless you are claiming the qualified plug-in electric vehicle credit in Part I . . . . . . . . 26

27 Tentative minimum tax:• Individuals. Enter the amount from Form 6251, line 33.• Corporations. Enter the amount from Form 4626, line 12.• Estates and trusts. Enter the amount from Schedule I (Form 1041), line 54.

} . . . . . . 27

28 Subtract line 27 from line 26. If zero or less, stop here; do not file this form unless you are claiming the qualified plug-in electric vehicle credit in Part I . . . . . . . . . . . . . 28

29 Qualified electric vehicle credit. Enter the smaller of line 23 or line 28. Report the total of this amount and the amount, if any, from line 22 on Form 1040, line 53; Form 1040NR, line 50; Form 1120, Schedule J, line 5b; or the appropriate line of your return. If line 28 is smaller than line 23, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ 29


Purpose of FormUse Form 8834 to claim the qualified plug-in electric vehicle credit and any qualified electric vehicle passive activity credits allowed for the current tax year.

The qualified plug-in electric vehicle credit attributable to depreciable property (vehicles used for business or investment purposes) is treated as a general business credit. Any credit not attributable to depreciable property is treated as a personal credit allowed against both the regular tax and the alternative minimum tax.

Taxpayers that are not partnerships or S corporations, and whose only source of this credit is from those pass-through entities, are not required to complete or file this form. Instead, they can report this credit directly on line 1z of Form 3800.

Qualified Plug-in Electric Vehicle CreditQualified Plug-in Electric VehicleThis is a vehicle made by a manufacturer that is propelled to a significant extent by an electric motor that draws electricity from a battery that can be recharged from an external source of electricity and has a capacity of not less than:

• 2.5 kilowatt hours if the vehicle has 2 or 3 wheels, or

• 4 kilowatt hours if the vehicle has 4 wheels.

The vehicle must also be either:

• A low speed vehicle, or

• A vehicle with 2 or 3 wheels that, according to the manufacturer, has a loaded weight (GVWR) of less than 14,000 pounds.

A low speed vehicle is a vehicle that:

• Has 4 wheels,

• Can attain a speed of more than 20 but not more than 25 miles per hour after 1 mile on a paved level surface, and

• According to the manufacturer, has a loaded weight (GVWR) of less than 3,000 pounds.

Certification and other requirements. Generally, you can rely on the manufacturer’s (or, in the case of a foreign manufacturer, its domestic distributor’s) certification that a specific make, model, and model year vehicle qualifies for the credit.

If, however, the IRS publishes an announcement that the certification for any specific make, model, and model year vehicle has been withdrawn, you cannot rely on the certification for such a vehicle purchased after the date of publication of the withdrawal announcement.

If you purchased a vehicle and its certification was withdrawn on or after the date of purchase, you can rely on such certification even if you had not placed the vehicle in service or claimed the credit by the date the withdrawal announcement was published by the IRS. The IRS will not attempt to collect any understatement of tax liability attributable to reliance on the certification as long as you purchased the vehicle on or before the date the IRS published the withdrawal announcement.


Version A, Cycle 1

orm 8835Department of the Treasury Internal Revenue Service

Renewable Electricity, Refined Coal, and Indian Coal Production Credit

� See separate instructions. � Attach to your tax return.

OMB No. 1545-1362



Part I Electricity Produced at Qualified Facilities Placed in Service Prior to October 23, 20041 Kilowatt-hours produced and sold (see instructions) . . . � 0.022 12 Phaseout adjustment (see instructions) . . . . . . . $ � 23 Credit before reduction. Subtract line 2 from line 1 . . . . . . . . . . . . . . . 3

Reduction for government grants, subsidized financing, and other credits:4 Total of government grants, proceeds of tax-exempt government obligations, subsidized energy financing,

and any federal tax credits allowed for the project for this and all prior tax years (see instructions) . . .5 Total of additions to the capital account for the project for this and all prior tax years . . . . 5 6 Divide line 4 by line 5. Show as a decimal carried to at least 4 places . . . . . . . . . 6 7 Multiply line 3 by line 6 . . . . . . . . . . . . . . . . . . . . . . . . 78 Subtract line 7 from line 3 . . . . . . . . . . . . . . . . . . . . . . . 89 Part I renewable electricity production credit from partnerships, S corporations, cooperatives,

estates, and trusts . . . . . . . . . . . . . . . . . . . . . . . . . . 910 Add lines 8 and 9. Cooperatives, estates, and trusts, go to line 11; partnerships and S corporations,

report this amount on Schedule K; all others, report this amount on Form 3800, line 1f . . . . 1011 Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust (see instructions) 1112 Cooperatives, estates, and trusts. Subtract line 11 from line 10. Report this amount on Form 3800, line 1f 12Part II Electricity and Refined Coal Produced at Qualified Facilities Placed in Service After

October 22, 2004 (After October 2, 2008, for Electricity Produced From Marine and Hydrokinetic Renewables), and Indian Coal Produced at Facilities Placed in Service After August 8, 2005

13

Electricity produced at qualified facilities using:

(a) Kilowatt-hours produced

and sold (see instructions)

(b) Rate

(c) Column (a) x Column (b)

a Wind . . . . . . . . 13a 0.022b Closed-loop biomass. . . . 13b 0.022c Geothermal . . . . . . 13c 0.022d Solar . . . . . . . . 13d 0.022e Add column (c) of lines 13a through 13d and enter here . . . . . . . . . . . . 13e

14




(b) Rate


a Open-loop biomass . . . . 14a 0.011b Small irrigation power . . . 14b 0.011c Landfill gas. . . . . . . 14c 0.011d Trash . . . . . . . . 14d 0.011e Hydropower . . . . . . 14e 0.011f Marine and hydrokinetic

renewables . . . . . . 14f 0.011g Add column (c) of lines 14a through 14f and enter here . . . . . . . . . . . . . . . 14g

15 Add lines 13e and 14g . . . . . . . . . . . . . . . . . . . . . . . . . 1516 Phaseout adjustment (see instructions) . . . . . . . $ � 16 17 Subtract line 16 from line 15 . . . . . . . . . . . . . . . . . . . . . . 17

Refined coal produced at a qualified refined coal production facility18 Tons produced and sold (see instructions) . . . . . . � $6.27 18 19 Phaseout adjustment (see instructions) . . . . . . . $ � 19 20 Subtract line 19 from line 18 . . . . . . . . . . . . . . . . . . . . . . 20

Steel industry fuel produced at a qualified refined coal production facility21 Barrel-of-oil equivalents produced and sold (see instructions) � $2.87 21

Indian coal produced at a qualified Indian coal production facility22 Tons produced and sold (see instructions) . . . . . . � $2.20 22

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 14954R Form 8835 (2010)

23 Credit before reduction. Add lines 17, 20, 21, and 22 . . . . . . . . . . . . . . 23

4


Version A, Cycle 1

Form 8835 (2010) Page 2Reduction for government grants, subsidized financing, and other credits:

24 Total of government grants, proceeds of tax-exempt government obligations, subsidized energy financing, and any federal tax credits allowed for the project for this and all prior tax years (see instructions) . . . 24

25 Total of additions to the capital account for the project for this and all prior tax years . . . . 2526 Divide line 24 by line 25. Show as a decimal carried to at least 4 places . . . . . . . . 2627 Multiply line 23 by the smaller of 1/2 or line 26 . . . . . . . . . . . . . . . . . 2728 Subtract line 27 from line 23 . . . . . . . . . . . . . . . . . . . . . . 2829 Part II renewable electricity, refined coal, and Indian coal production credit from partnerships,

S corporations, cooperatives, estates, and trusts . . . . . . . . . . . . . . . . 2930 Add lines 28 and 29. Partnerships and S corporations, report this amount on Schedule K; all

others continue to line 31 . . . . . . . . . . . . . . . . . . . . . . . 3031 Renewable electricity, refined coal, and Indian coal production credit included on line 30 from

passive activities (see instructions) . . . . . . . . . . . . . . . . . . . . 3132 Subtract line 31 from line 30 . . . . . . . . . . . . . . . . . . . . . . 3233 Renewable electricity, refined coal, and Indian coal production credit allowed for 2010 from a passive

activity (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 3334 Carryforward of renewable electricity, refined coal, and Indian coal production credit to 2010 . . . 3435 Carryback of renewable electricity, refined coal, and Indian coal production credit from 2011 (see

instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

36 Add lines 32 through 35. Cooperatives, estates, and trusts, go to line 37; All others: For electricity, refined coal, or Indian coal produced during the 4-year period beginning on the date the facility was placed in service, report the applicable part of this amount on Form 3800, line 29e; for all other production of electricity, refined coal, or Indian coal, report the applicable part of this amount on Form 3800, line 1f . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

37 Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust (see instructions) 3738 Cooperatives, estates, and trusts. Subtract line 37 from line 36. For electricity, refined coal, or Indian coal

produced during the 4-year period beginning on the date the facility was placed in service, report the applicable part of this amount on Form 3800, line 29e; for all other production of electricity, refined coal, or Indian coal, report the applicable part of this amount on Form 3800, line 1f . . . . . . . . . . 38

Form 8835 (2010)


Version A, Cycle 3


Qualified Adoption Expenses Attach to Form 1040 or 1040NR.


OMB No. 1545-0074



Part I Information About Your Eligible Child or Children—You must complete this part. See instructions for details, including what to do if you need more space.

1(a)

Child’s name(b)

Child’s year of birth

Check if child was—

(c) born before

1993 and disabled

(d) a child

with special needs

(e) a

foreign child

(f) Child’s

identifying number

(g) Check if adoption

became final in 2010 or earlier First Last

Child 1

Child 2

Child 3

Caution. If the child was a foreign child, see Special rules in the instructions for line 1, column (e) before you complete Part II or Part III. If you received employer-provided adoption benefits, complete Part III on the back next.

Part II Adoption CreditChild 1 Child 2 Child 3

2 Maximum adoption credit per child . . . . . . . . 2 $13,170 00 $13,170 00 $13,170 00

3 Did you file Form 8839 for a prior year for the same child?

No. Enter -0-.Yes. See instructions for the amount to enter.

} 3

4 Subtract line 3 from line 2 . 4 5 Qualified adoption expenses

(see instructions) . . . . 5

Caution. Your qualified adoption expenses may not be equal to the adoption expenses you paid in 2010.

6 Enter the smaller of line 4 or line 5 6 7 Add the amounts on line 6. If zero, skip lines 8 through 11 and enter -0- on line 12 . . . . . 7 8 Enter modified adjusted gross income (see instructions) . . . . 8 9 Is line 8 more than $182,520?

No. Skip lines 9 and 10, and enter -0- on line 11.Yes. Subtract $182,520 from line 8 . . . . . . . . . 9

10 Divide line 9 by $40,000. Enter the result as a decimal (rounded to at least three places). Do not enter more than 1.000 . . . . . . . . . . . . . . . . . . . . . . 10 .

11 Multiply line 7 by line 10 . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Subtract line 11 from line 7 . . . . . . . . . . . . . . . . . . . . . . . 12 13 Credit carryforward from prior years (line 23 of your Credit Carryforward Worksheet on page 5

of the 2009 Form 8839 instructions) . . . . . . . . . . . . . . . . . . . . 13 14 Add lines 12 and 13. This your Adoption Credit. Include this amount on Form 1040, line 71, or

Form 1040NR, line 66. Check box b on that line . . . . . . . . . . . . . . . . 14 For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 22843L


Version A, Cycle 3

Form 8839 (2010) Page 2

Part III Employer-Provided Adoption Benefits

Child 1 Child 2 Child 3

15 Maximum exclusion per child 15 $13,170 00 $13,170 00 $13,170 00

16 Did you receive employer-provided adoption benefits for a prior year for the same child?

No. Enter -0-.Yes. See instructions for the amount to enter.

} 16

17 Subtract line 16 from line 15 17

18 Employer-provided adoption benefits you received in 2010. This amount should be shown in box 12 of your 2010 Form(s) W-2 with code T . . . . 18

19 Add the amounts on line 18 . . . . . . . . . . . . . . . . . . . . . . . 19

20 Enter the smaller of line 17 or line 18. But if the child was a child with special needs and the adoption became final in 2010, enter the amount from line 17 20

21 Add the amounts on line 20. If zero, skip lines 22 through 25, enter -0- on line 26, and go to line 27 . . . . . . . . . . . 21

22 Enter modified adjusted gross income (from the worksheet in the instructions) 22

23 Is line 22 more than $182,520?No. Skip lines 23 and 24, and enter -0- on line 25.Yes. Subtract $182,520 from line 22 . . . . . . . . . . . 23

24 Divide line 23 by $40,000. Enter the result as a decimal (rounded to at least three places). Do not enter more than 1.000 . . . . . 24 .

25 Multiply line 21 by line 24 . . . . . . . . . . . . . 25

26 Excluded benefits. Subtract line 25 from line 21 . . . . . . . . . . . . . . . . 26

27 Taxable benefits. Is line 26 more than line 19?

No. Subtract line 26 from line 19. Also, include this amount, if more than zero, on line 7 of Form 1040 or line 8 of Form 1040NR. On the dotted line next to line 7 of Form 1040 or line 8 of Form 1040NR, enter “AB.”

Yes. Subtract line 19 from line 26. Enter the result as a negative number. Reduce the total you would enter on line 7 of Form 1040 or line 8 of Form 1040NR bythe amount on Form 8839, line 27. Enter the result on line 7 of Form 1040 or line 8 of Form 1040NR. Enter “SNE” on the dotted line next to the entry line.

} . . 27

TIP

You may be able to claim the adoption credit in Part II on the front of this form if any of the following apply.

• You paid adoption expenses in 2009, those expenses were not fully reimbursed by your employer or otherwise, and the adoption was not final by the end of 2009.

• The total adoption expenses you paid in 2010 were not fully reimbursed by your employer or otherwise, and the adoption became final in 2010 or earlier.

• You adopted a child with special needs and the adoption became final in 2010.

Form 8839 (2010)



Empowerment Zone and Renewal Community Employment Credit


OMB No. 1545-1444



1 Enter the total qualified wages paid or incurred during calendar year 2010 only (see instructions)a Qualified empowerment zone wages . . . . . . $ × 20% (.20) 1ab Skip line 1b (see instructions) . . . . . . . . . $ × 0% (.00) 1b

2 Enter the amount from line 1a. See instructions for the adjustment you must make to salaries and wages 2

3 Empowerment zone and renewal community employment credit from partnerships, S corporations, cooperatives, estates, and trusts . . . . . . . . . . . . . . . . . . . . . . . 3

4 Add lines 2 and 3. Partnerships and S corporations, report this amount on Schedule K; all others, go to line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Empowerment zone and renewal community employment credit included on line 4 from passive activities (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . 5


7 Passive activity credit allowed for 2010 (see instructions) . . . . . . . . . . . . . . . 7

8 Carryforward of empowerment zone and renewal community employment credit to 2010 . . . . . 8

9 Carryback of empowerment zone employment credit from 2011 (see instructions) 9

10 Add lines 6 through 9. Cooperatives, estates, and trusts, go to line 11. All others, report this amount on Form 3800, line 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Amount allocated to the patrons of the cooperative or the beneficiaries of the estate or trust (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 Cooperatives, estates, and trusts. Subtract line 11 from line 10. Report this amount on Form 3800, line 24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

For Paperwork Reduction Act Notice, see instructions. Cat. No. 16145S Form 8844 (2010)



Credit for Employer Social Security and Medicare Taxes Paid on Certain Employee Tips


OMB No. 1545-1414



Note. Claim this credit only for social security and Medicare taxes paid by a food or beverage establishment where tipping is customary for providing food or beverages. See the instructions for line 1.

1 Tips received by employees for services on which you paid or incurred employer social security and Medicare taxes during the tax year (see instructions) . . . . . . . . . . . . . 1

2 Tips not subject to the credit provisions (see instructions) . . . . . . . . . . . . . 2 3 Creditable tips. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . 3

4 Multiply line 3 by 7.65% (.0765). If you had any tipped employees whose wages (including tips) exceeded $106,800 or were exempt from social security taxes, see instructions and check here . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ 4

5 Credit for employer social security and Medicare taxes paid on certain employee tips frompartnerships and S corporations . . . . . . . . . . . . . . . . . . . . . 5

6 Add lines 4 and 5. Partnerships and S corporations, report this amount on Schedule K; all others, go to line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Credit for employer social security and Medicare taxes paid on certain employee tips included on line 6 from passive activities (see instructions) . . . . . . . . . . . . . . . . 7

8 Subtract line 7 from line 6 . . . . . . . . . . . . . . . . . . . . . . . 8 9 Credit for employer social security and Medicare taxes paid on certain employee tips allowed for

2010 from passive activities (see instructions) . . . . . . . . . . . . . . . . . 9 10 Carryforward of the credit for employer social security and Medicare taxes paid on certain

employee tips that originated in a tax year that began after 2006 (see instructions) . . . . . 10 11 Carryback of the credit for employer social security and Medicare taxes paid on certain

employee tips from 2011 (see instructions) . . . . . . . . . . . . . . . . . 11 12 Add lines 8 through 11. Report this amount on Form 3800, line 29f . . . . . . . . . . 12

General InstructionsSection references are to the Internal Revenue Code.

Purpose of FormCertain food and beverage establishments (see Who Should File below) use Form 8846 to claim a credit for social security and Medicare taxes paid or incurred by the employer on certain employees’ tips. The credit is part of the general business credit.

You can claim or elect not to claim the credit any time within 3 years from the due date of your return on either your original return or on an amended return.

Who Should FileFile Form 8846 if you meet both of the following conditions.

1. You had employees who received tips from customers for providing, delivering, or serving food or beverages for consumption if tipping of employees for delivering or serving food or beverages is customary.

2. During the tax year, you paid or incurred employer social security and Medicare taxes on those tips.

How the Credit Is FiguredGenerally, the credit equals the amount of employer social security and Medicare taxes paid or incurred by the employer on tips received by the employee. However, the amount of tips for any month that are used to figure the credit must be reduced by the amount by which the wages that would have been payable during that month at $5.15 an hour exceed the wages (excluding tips) paid by the employer during that month.

For example, an employee worked 100 hours and received $450 in tips for October 2010. The worker received $375 in wages (excluding tips) at the rate of $3.75 an hour. If the employee had been paid $5.15 an hour, the employee would have received wages, excluding tips, of $515. For credit purposes, the $450 in tips is reduced by $140 (the difference between $515 and $375), and only $310 of the employee’s tips for October 2010 is taken into account.

Specific InstructionsFigure the current year credit from your trade or business on lines 1 through 4.

Line 1Enter the tips received by employees for services on which you paid or incurred employer social security and Medicare taxes during the tax year.

Include tips received from customers for providing, delivering, or serving food or beverages for consumption if tipping of employees for delivering or serving food or beverages is customary.

Line 2If you pay each tipped employee wages (excluding tips) equal to or more than $5.15 an hour enter zero on line 2.

Figure the amount of tips included on line 1 that are not creditable for each employee on a monthly basis. This is the total amount that would be payable to the employee at $5.15 an hour reduced by the wages (excluding tips) actually paid to the employee during the month. Enter on line 2 the total amounts figured for all employees.

For Paperwork Reduction Act Notice, see back of form. Cat. No. 16148Z Form 8846 (2010)

SSTIPCAP


Version A, Cycle 1


Archer MSAs and Long-Term Care Insurance Contracts

▶ Attach to Form 1040 or Form 1040NR. ▶ See separate instructions.

OMB No. 1545-0074


Name(s) shown on return Social security number of MSA account holder. If both spouses have MSAs, see page 1 of the instructions ▶

Section A. Archer MSAs. If you have only a Medicare Advantage MSA, skip Section A and complete Section B.Part I Archer MSA Contributions and Deductions. See page 2 of the instructions before completing this part. If

you are filing jointly and both you and your spouse have high deductible health plans with self-only coverage, complete a separate Part I for each spouse.

1 Total employer contributions to your Archer MSA(s) for 2010 . . . . 12 Archer MSA contributions you made for 2010, including those made from January 1, 2011,

through April 15, 2011, that were for 2010. Do not include rollovers (see page 2 of the instructions) 23 Limitation from the worksheet on page 3 of the instructions . . . . . . . . . . . . . 34 Compensation (see page 3 of the instructions) from the employer maintaining the high deductible

health plan. (If self-employed, enter your earned income from the trade or business under which the high deductible health plan was established.) . . . . . . . . . . . . . . . . . 4

5 Archer MSA deduction. Enter the smallest of line 2, 3, or 4 here. Also include this amount onForm 1040, line 36, or Form 1040NR, line 34. On the dotted line next to Form 1040, line 36, or Form 1040NR, line 34, enter “MSA” and the amount . . . . . . . . . . . . . . . . 5Caution: If line 2 is more than line 5, you may have to pay an additional tax (see page 3 of the instructions).

Part II Archer MSA Distributions6a Total distributions you and your spouse received in 2010 from all Archer MSAs (see page 4 of the

instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6ab Distributions included on line 6a that you rolled over to another Archer MSA or a health savings

account. Also include any excess contributions (and the earnings on those excess contributions) included on line 6a that were withdrawn by the due date of your return (see page 4 of theinstructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6b

c Subtract line 6b from line 6a . . . . . . . . . . . . . . . . . . . . . . . 6c7 Unreimbursed qualified medical expenses (see page 4 of the instructions) . . . . . . . . 78 Taxable Archer MSA distributions. Subtract line 7 from line 6c. If zero or less, enter -0-. Also

include this amount in the total on Form 1040, line 21, or Form 1040NR, line 21. On the dotted line next to line 21, enter “MSA” and the amount . . . . . . . . . . . . . . . . . 8

9a If any of the distributions included on line 8 meet any of the Exceptions to the Additional 15% Tax (see page 4 of the instructions), check here . . . . . . . . . . . . . ▶

b Additional 15% tax (see page 4 of the instructions). Enter 15% (.15) of the distributions included on line 8 that are subject to the additional 15% tax. Also include this amount in the total on Form1040, line 60, or Form 1040NR, line 57. On the dotted line next to Form 1040, line 60, or Form1040NR, line 57, enter “MSA” and the amount . . . . . . . . . . . . . . . . . 9b

Section B. Medicare Advantage MSA Distributions. If you are filing jointly and both you and your spouse received distributions in 2010 from a Medicare Advantage MSA, complete a separate Section B for each spouse (see page 4 of the instructions).

10 Total distributions you received in 2010 from all Medicare Advantage MSAs (see page 5 of the instructions) 1011 Unreimbursed qualified medical expenses (see page 5 of the instructions) . . . . . . . . 1112 Taxable Medicare Advantage MSA distributions. Subtract line 11 from line 10. If zero or less,

enter -0-. Also include this amount in the total on Form 1040, line 21, or Form 1040NR, line 21. On the dotted line next to line 21, enter “Med MSA” and the amount . . . . . . . . . . 12

13a If any of the distributions included on line 12 meet any of the Exceptions to the Additional 50% Tax (see page 5 of the instructions), check here . . . . . . . . . . . . . ▶

13b

b Additional 50% tax (see page 5 of the instructions). Also include this amount in the total on Form1040, line 60, or Form 1040NR, line 57. On the dotted line next to Form 1040, line 60, or Form1040NR, line 57, enter “Med MSA” and the amount . . . . . . . . . . . . . . . .

For Paperwork Reduction Act Notice, see your tax return. Cat. No. 24091H Form 8853 (2010)


Version A, Cycle 1

Form 8853 (2010) Attachment Sequence No. 39 Page 2 Name of policyholder (as shown on Form 1040) Social security number of

policyholder ▶

Section C. Long-Term Care (LTC) Insurance Contracts. See Filing Requirements for Section C on page 6 of theinstructions before completing this section.

If more than one Section C is attached, check here . . . . . . . . . . . . . . . . . . . . . . ▶

14a Name of insured ▶ b Social security number of insured ▶

15 In 2010, did anyone other than you receive payments on a per diem or other periodic basis under a qualified LTC insurance contract covering the insured or receive accelerated death benefits under a lifeinsurance policy covering the insured? . . . . . . . . . . . . . . . . . . . . . . . Yes No

16 Was the insured a terminally ill individual? . . . . . . . . . . . . . . . . . . . . . . Yes NoNote: If “Yes” and the only payments you received in 2010 were accelerated death benefits that were paid to you because the insured was terminally ill, skip lines 17 through 25 and enter -0- on line 26.

17 Gross LTC payments received on a per diem or other periodic basis. Enter the total of theamounts from box 1 of all Forms 1099-LTC you received with respect to the insured on which the“Per diem” box in box 3 is checked . . . . . . . . . . . . . . . . . . . . . 17

Caution: Do not use lines 18 through 26 to figure the taxable amount of benefits paid under an LTC insurance contract that is not a qualified LTC insurance contract. Instead, if the benefits are not excludable from your income (for example, if the benefits are not paid for personal injuries or sickness through accident or health insurance), report the amount not excludable as income onForm 1040, line 21.

18 Enter the part of the amount on line 17 that is from qualified LTC insurance contracts . . . . 1819 Accelerated death benefits received on a per diem or other periodic basis. Do not include any

amounts you received because the insured was terminally ill (see page 7 of the instructions) . . 19

20 Add lines 18 and 19 . . . . . . . . . . . . . . . . . . . . . . . . . . 20Note: If you checked “Yes” on line 15 above, see Multiple Payees onpage 7 of the instructions before completing lines 21 through 25.

21 Multiply $290 by the number of days in the LTC period . . . . . . 2122 Costs incurred for qualified LTC services provided for the insured

during the LTC period (see page 7 of the instructions) . . . . . . 22

23 Enter the larger of line 21 or line 22 . . . . . . . . . . . . 2324 Reimbursements for qualified LTC services provided for the insured

during the LTC period . . . . . . . . . . . . . . . . . 24Caution: If you received any reimbursements from LTC contractsissued before August 1, 1996, see page 7 of the instructions.

25 Per diem limitation. Subtract line 24 from line 23 . . . . . . . . . . . . . . . . . 2526 Taxable payments. Subtract line 25 from line 20. If zero or less, enter -0-. Also include this

amount in the total on Form 1040, line 21. On the dotted line next to line 21, enter “LTC” and theamount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Form 8853 (2010)



Education Credits (American Opportunity and Lifetime Learning Credits)

▶ See separate instructions to find out if you are eligible to take the credits. ▶ Attach to Form 1040 or Form 1040A.

OMB No. 1545-0074



Part I American Opportunity Credit Caution: You cannot take the American opportunity credit for more than 4 tax years for the same student.

1 (a) Student’s name (as shown on page 1

of your tax return) First name Last name

(b) Student’s social security

number (as shown on page 1 of your tax return)

(c) Qualified expenses (see

instructions). Do not enter more than $4,000 for each student.

(d) Subtract $2,000 from the amount in column (c). If zero or less, enter -0-.

(e) Multiply the amount in column (d) by 25% (.25)

(f) If column (d) is zero, enter the amount from column (c). Otherwise,

add $2,000 to the amount in column (e).

2

Tentative American opportunity credit. Add the amounts on line 1, column (f). If you are taking the lifetime learning credit for a different student, go to Part II; otherwise, go to Part III . . . . . . ▶ 2

Part II Lifetime Learning Credit Caution: You cannot take the American opportunity credit and the lifetime learning credit for the same student in the same year.

3 (a) Student’s name (as shown on page 1 of your tax return) (b) Student’s social security number (as shown on page

1 of your tax return)

(c) Qualified expenses (see instructions) First name Last name

4 Add the amounts on line 3, column (c), and enter the total . . . . . . . . . . . . . . . 45 Enter the smaller of line 4 or $10,000 . . . . . . . . . . . . . . . . . . . . . 56 Tentative lifetime learning credit. Multiply line 5 by 20% (.20). If you have an entry on line 2, go to

Part III; otherwise go to Part IV . . . . . . . . . . . . . . . . . . . . . . . 6For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 25379M Form 8863 (2010)

You cannot take both an education credit and the tuition and fees deduction (see Form 8917) for the same student for the same year.▲!

CAUTION

Number of students


Form 8863 (2010) Page 2 Part III Refundable American Opportunity Credit

7 Enter the amount from line 2. . . . . . . . . . . . . . . . . . . . . . . . . 78

Enter: $180,000 if married filing jointly; $90,000 if single, head of household, or qualifying widow(er) . . . . . . . . . . . . . 8

9 Enter the amount from Form 1040, line 38,* or Form 1040A, line 22 . . . 910

Subtract line 9 from line 8. If zero or less, stop; you cannot take anyeducation credit . . . . . . . . . . . . . . . . . . . 10

11

Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er) . . . . . . . . . . . . . . . . . 11

12 If line 10 is: • Equal to or more than line 11, enter 1.000 on line 12 . . . . . . . . . . .

• Less than line 11, divide line 10 by line 11. Enter the result as a decimal (rounded to at least three places) . . . . . . . . . . . . . . . . . . . . .

} . . . . 12

13

Multiply line 7 by line 12. Caution: If you were under age 24 at the end of the year and meet the conditions on page 4 of the instructions, you cannot take the refundable American opportunity credit. Skip line 14, enter the amount from line 13 on line 15, and check this box . . ▶ 13

14

Refundable American opportunity credit. Multiply line 13 by 40% (.40). Enter the amount here and on Form 1040, line 66, or Form 1040A, line 43. Then go to line 15 below . . . . . . . . . 14

Part IV Nonrefundable Education Credits15 Subtract line 14 from line 13 . . . . . . . . . . . . . . . . . . . . . . . 1516

Enter the amount from line 6, if any. If you have no entry on line 6, skip lines 17 through 22, and enter the amount from line 15 on line 6 of the Credit Limit Worksheet (see instructions) . . . . 16

17

Enter: $120,000 if married filing jointly; $60,000 if single, head of household, or qualifying widow(er) . . . . . . . . . . . . . 17

18 Enter the amount from Form 1040, line 38,* or Form 1040A, line 22 . . . 1819

Subtract line 18 from line 17. If zero or less, skip lines 20 and 21, and enter zero on line 22 . . . . . . . . . . . . . . . . . . . . 19

20

Enter: $20,000 if married filing jointly; $10,000 if single, head of household, or qualifying widow(er) . . . . . . . . . . . . . . . . . 20

21 If line 19 is: • Equal to or more than line 20, enter 1.000 on line 21 and go to line 22 • Less than line 20, divide line 19 by line 20. Enter the result as a decimal (rounded to at least three

places) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2122 Multiply line 16 by line 21. Enter here and on line 1 of the Credit Limit Worksheet (see instructions) ▶ 2223

Nonrefundable education credits. Enter the amount from line 11 of the Credit Limit Worksheet (see instructions) here and on Form 1040, line 49, or Form 1040A, line 31 . . . . . . . . . 23*If you are filing Form 2555, 2555-EZ, or 4563, or you are excluding income from Puerto Rico, see Pub. 970 for the amount to enter.

Form 8863 (2010)



Biodiesel and Renewable Diesel Fuels Credit


OMB No. 1545-1924



Caution. You cannot claim any amounts on Form 8864 that you claimed (or will claim) on Schedule C (Form 720), Form 8849, or Form 4136.

Claimant has a certificate from the producer or importer of biodiesel or renewable diesel reported on lines 1 through 6 below and, if applicable, claimant also has a statement from the reseller. Claimant has no reason to believe that the information in the certificate or statement is false. Claimant may need to attach a copy of the certificate and statement. See Certification below.

Type of Fuel(a)

Number of Gallons Sold or Used

(b) Rate


1 Biodiesel (other than agri-biodiesel) sold or used after 2008 and before 2010 . . . . . . . . . . . . . . . 1 $1.00

2 Agri-biodiesel sold or used after 2008 and before 2010 . . . 2 $1.003 Renewable diesel sold or used after 2008 and before 2010. . 3 $1.004 Biodiesel (other than agri-biodiesel) included in a biodiesel

mixture sold or used after 2008 and before 2010 . . . . . 4 $1.005 Agri-biodiesel included in a biodiesel mixture sold or used

after 2008 and before 2010 . . . . . . . . . . . . 5 $1.00

6 Renewable diesel included in a renewable diesel mixture sold or used after 2008 and before 2010 . . . . . . . . . 6 $1.00

7 Qualified agri-biodiesel production produced, and sold or used, after 2008 and before 2010 . . . . . . . . . . 7 $ .10

8 Add lines 1 through 7. Include this amount in your income for 2009 (see instructions) . . . . . 89 Biodiesel and renewable diesel fuels credit from partnerships, S corporations, cooperatives,

estates, and trusts (see instructions) . . . . . . . . . . . . . . . . . . . . . 910 Add lines 8 and 9. Cooperatives, estates, and trusts, go to line 11; partnerships and

S corporations, report this amount on Schedule K; all others, report this amount on Form 3800, line 1l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 Cooperatives, estates, and trusts. Subtract line 11 from line 10. Report this amount on Form 3800, line 1l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

For Paperwork Reduction Act Notice, see instructions. Cat. No. 25778F Form 8864 (2009)

Nondeductible Credit


Form

8874

Department of the TreasuryInternal Revenue Service

Name(s) shown on return

Cat. No. 31663N

Form 8874 (Rev. 1-2007)


Identifying number

(e)

Creditrate

(d)Amount of qualifiedequity investment

(c)Date of initialinvestment

(b)Employer identification

number of CDE

(a)Name and address of the qualified

community development entity (CDE)

1

(f)Credit ((d) � (e))

3

%

%

%

3

For Paperwork Reduction Act Notice, see instructions.

2

New markets credit from partnerships and S corporations

2

(Rev. January 2007)

Add lines 1 and 2. Partnerships and S corporations, report this amount on Schedule K; all others, report this amount on the applicable line of Form 3800, (e.g., line 1l of the 2006 Form 3800)

OMB No. 1545-1804

New Markets Cr edit


%

%

%

Generally, a qualified CDE can designate an equityinvestment as a qualified equity investment only if it appliedfor and received a new markets credit allocation and enteredinto an allocation agreement with the CDFI Fund before theequity investment was made.

Qualified CDEs also include specialized small businessinvestment companies and community development financialinstitutions. See section 45D(c)(2).

Exceptions. An equity investment in an entity that otherwisequalifies as a qualified equity investment is eligible to bedesignated as a qualified equity investment if made prior to anallocation agreement only if either of the following applies. ● The equity investment was made on or after April 20, 2001,and the designation of the equity investment as a qualifiedequity investment is made for a credit allocation receivedunder an allocation application submitted to the CDFI Fund nolater than August 29, 2002. If the entity in which the equityinvestment is made does not receive an allocation under anallocation application submitted no later than August 29, 2002,the equity investment will not be eligible to be designated as aqualified equity investment. For details, see Regulationssections 1.45D-1(c)(3)(ii)(A) and 1.45D-1(c)(3)(iii).

Qualified Equity Investment A qualified equity investment is an interest in a qualified CDEin the form of stock (other than nonqualified preferred stock) ina corporation or a capital interest in a partnership that meetsall of the following requirements. ● You acquired the investment solely for cash at its originalissue (or from a taxpayer for whom the investment was aqualified equity investment). The cash may be from borrowedfunds, including a nonrecourse loan. ● Substantially all (at least 85%) of the cash is used to makequalified low-income community investments. The 85%requirement is reduced to 75% for the seventh year of the7-year credit period. ● The investment was designated as a qualified equityinvestment by the CDE on its books and records for purposesof the new markets credit.

General Instructions

Use Form 8874 to claim the new markets credit for qualifiedequity investments made in qualified community developmententities (CDEs). This credit is part of the general businesscredit.

What’s New

Section references are to the Internal Revenue Code unlessotherwise noted.

Purpose of Form

A qualified CDE is a domestic corporation or partnership thatmeets the following requirements. ● Its primary mission is serving, or providing investmentcapital for, low-income communities or persons. ● It maintains accountability to residents of low-incomecommunities through their representation on any governingboard or advisory board of the entity. ● It is certified as a qualified CDE by the CommunityDevelopment Financial Institutions (CDFI) Fund of theDepartment of the Treasury.

Qualified CDE

● The tax liability limit is no longer figured on this form.Instead, it must be figured on Form 3800, General BusinessCredit. ● Taxpayers that are not partnerships or S corporations, andwhose only source of this credit is from those pass-throughentities, are not required to complete or file this form. Instead,they can report this credit directly on line 1l of Form 3800. ● The IRS will revise the January 2007 version of the form onlywhen necessary. Continue to use this version for tax yearsbeginning after 2005 until a new revision is issued.

Definitions

TIP

Qualified CDEs must provide taxpayers holding aqualified equity investment with a completed Form8874-A when a qualified equity investment isacquired.



Credit for Qualified Retirement Savings Contributions▶ Attach to Form 1040, Form 1040A, or Form 1040NR.

▶ See instructions on back.

OMB No. 1545-0074



▲!CAUTION

You cannot take this credit if either of the following applies.• The amount on Form 1040, line 38; Form 1040A, line 22; or Form 1040NR, line 37 is more than $27,750 ($41,625 if head of household; $55,500 if married filing jointly).

• The person(s) who made the qualified contribution or elective deferral (a) was born after January 1, 1993, (b) is claimed as a dependent on someone else’s 2010 tax return, or (c) was a student (see instructions).

(a) You (b) Your spouse1 Traditional and Roth IRA contributions for 2010. Do not include rollover

contributions . . . . . . . . . . . . . . . . . . . . 1 2 Elective deferrals to a 401(k) or other qualified employer plan, voluntary

employee contributions, and 501(c)(18)(D) plan contributions for 2010 (see instructions) . . . . . . . . . . . . . . . . . . 2

3 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . 3 4 Certain distributions received after 2007 and before the due date

(including extensions) of your 2010 tax return (see instructions). Ifmarried filing jointly, include both spouses’ amounts in both columns. See instructions for an exception . . . . . . . . . . . . .

5 Subtract line 4 from line 3. If zero or less, enter -0- . . . . . . . 5 6 In each column, enter the smaller of line 5 or $2,000 . . . . . . 6 7 Add the amounts on line 6. If zero, stop; you cannot take this credit . . . . . . . . . . 7 8 Enter the amount from Form 1040, line 38*; Form 1040A, line 22; or

Form 1040NR, line 37 . . . . . . . . . . . . . . . . . 8 9 Enter the applicable decimal amount shown below:

If line 8 is—

Over—But not over—

And your filing status is—Married

filing jointlyHead of

householdSingle, Married filing

separately, or Qualifying widow(er)Enter on line 9—

--- $16,750 .5 .5 .5$16,750 $18,000 .5 .5 .2$18,000 $25,125 .5 .5 .1$25,125 $27,000 .5 .2 .1$27,000 $27,750 .5 .1 .1$27,750 $33,500 .5 .1 .0$33,500 $36,000 .2 .1 .0$36,000 $41,625 .1 .1 .0$41,625 $55,500 .1 .0 .0$55,500 --- .0 .0 .0

Note: If line 9 is zero, stop; you cannot take this credit.

9

10 Multiply line 7 by line 9 . . . . . . . . . . . . . . . . . . . . . . . . . 10 11 Enter the amount from Form 1040, line 46; Form 1040A, line 28; or

Form 1040NR, line 44 . . . . . . . . . . . . . . . . . 11 12 1040 filers: Enter the total of your credits from lines 47 through 49,

and Schedule R, line 22.

1040A filers: Enter the total of your credits from lines 29 through 31.

1040NR filers: Enter the total of your credits from lines 45 and 46.

}12

13 Subtract line 12 from line 11. If zero, stop; you cannot take this credit . . . . . . . . . . 13 14 Credit for qualified retirement savings contributions. Enter the smaller of line 10 or line 13

here and on Form 1040, line 50; Form 1040A, line 32; or Form 1040NR, line 47 . . . . . . . 14

*See Pub. 590 for the amount to enter if you are filing Form 2555, 2555-EZ, or 4563 or you are excluding income from Puerto Rico.

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 33394D Form 8880 (2010)

4


OMB No. 1545-0074 Health Coverage T ax Credit

8885 Form



� Attach to Form 1040, Form 1040NR, Form 1040-SS, or Form 1040-PR.

Name of recipient (if both spouses are recipients, complete a separate form for each spouse)

Recipient’s social security number

Form 8885 (2010) Cat. No. 34641D

Complete This Part To See if You Are Eligible To Take This Credit 1

Part I

Part II

Check the boxes below for each month in 2010 that all of the following statements were true on the first day of that month.

February

March

Health Coverage Tax Credit

2

Enter the total amount paid directly to your health plan for qualified health insurance coveragefor the months checked on line 1 (see instructions on page 3). Do not include on line 2 anyqualified health insurance premiums paid to “U.S. Treasury–HCTC” or any insurance premiums on coverage that was actually paid for with a National Emergency Grant. Also, do not includeany advance (monthly) payments or reimbursement credits you received, as shown on Form1099-H, box 1

3

For Paperwork Reduction Act Notice, see your tax return instructions.

Before you begin: See Definitions and Special Rules that begin on page 2.

January

May

June

April

August

September

July

November

December

October

Do not complete this form if you can be claimed as a dependent on someone else’s 2010 tax return.

● You were an eligible trade adjustment assistance (TAA) recipient, alternative TAA (ATAA) recipient, reemployment TAA(RTAA) recipient, or Pension Benefit Guaranty Corporation (PBGC) pension payee; or you were a qualified family memberof an individual who fell under one of the categories listed above when he or she passed away or with whom you finalized a divorce. ● You were covered by a qualified health insurance plan for which you paid the entire premiums, or your portion of thepremiums, directly to your health plan or to “U.S. Treasury–HCTC.”

● Your employer did not pay 50% or more of the cost of coverage.

● You were not enrolled in Medicaid or the Children’s Health Insurance Program (CHIP).

● You were not enrolled in the Federal Employees Health Benefits Program (FEHBP) or eligible to receive benefits underthe U.S. military health system (TRICARE). ● You were not imprisoned under federal, state, or local authority.

2

● You were not enrolled in Medicare Part A or Medicare Part B, or you were enrolled in Medicare but your family member(s) qualified for the HCTC.

You must attach the required documents listed on page 4 for anyamounts included on line 2. If you do not attach the required documents, your credit will be disallowed.

CAUTION

CAUTION

Enter the total amount of any Archer MSA or health savings accounts distributions used to pay for qualified health insurance coverage for the months checked on line 1

3

4

Subtract line 3 from line 2. If zero or less, stop; you cannot take the credit

4

5

Health Coverage Tax Credit. If you received an advance payment for any month not checked on line 1, see the instructions for line 5 on page 4. Otherwise, multiply the amount on line 4 by 80% (.80). Enter the result here and on Form 1040, line 71 (check box d); Form 1040NR, line 66 (check box d); Form 1040-SS, line 9; or Form 1040-PR, line 9

5

● You did not receive a 65% COBRA premium reduction from your former employer or COBRA administrator.

10

Number of boxes checked



Allocation of Refund (Including Savings Bond Purchases) ▶ See instructions.

▶ Attach to Form 1040, Form 1040A, Form 1040EZ, Form 1040NR, Form 1040NR-EZ, Form 1040-SS, or Form 1040-PR.

OMB No. 1545-0074



Part I Direct DepositComplete this part if you want us to directly deposit a portion of your refund to one or more accounts.

1a Amount to be deposited in first account . . . . . . . . . . . . . . . . . . . 1a

b Routing number ▶ c Checking Savings

d Account number

2 a Amount to be deposited in second account . . . . . . . . . . . . . . . . . . 2a


d Account number

3 a Amount to be deposited in third account . . . . . . . . . . . . . . . . . . . 3a


d Account number

Part II U.S. Series I Savings Bond PurchasesComplete this part if you want to buy paper bonds with a portion of your refund.

▲!CAUTION

If a name is entered on line 5c or 6c below, co-ownership will be assumed unless the beneficiary box is checked. See instructions for more details.

4 Amount to be used for bond purchases for yourself (and your spouse, if filing jointly). . . . . . 4

5a Amount to be used to buy bonds for yourself, your spouse, or someone else . . . . . . . 5a b Enter the owner's name (First Last) for the bond registration

c If you would like to add a co-owner or beneficiary, enter the name here (First Last). If beneficiary, also check here ▶

6a Amount to be used to buy bonds for yourself, your spouse, or someone else . . . . . . . 6a b Enter the owner's name (First Last) for the bond registration

c If you would like to add a co-owner or beneficiary, enter the name here (First Last). If beneficiary, also check here ▶

Part III Paper CheckComplete this part if you want a portion of your refund to be sent to you as a check.

7 Amount to be refunded by check . . . . . . . . . . . . . . . . . . . . . . 7Part IV Total Allocation of Refund8 Add lines 1a, 2a, 3a, 4, 5a, 6a, and 7. The total must equal the amount shown on Form 1040, line

74a; Form 1040A, line 46a; Form 1040EZ, line 12a; Form 1040NR, line 70a; Form 1040NR-EZ, line 23a; Form 1040-SS, line 12a; or Form 1040-PR, line 12a . . . . . . . . . . . . . . 8

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 21858A Form 8888 (2010)



Health Savings Accounts (HSAs) ▶ Attach to Form 1040 or Form 1040NR. ▶ See separate instructions.

OMB No. 1545-0074


Name(s) shown on Form 1040 or Form 1040NR Social security number of HSA beneficiary. If both spouses have HSAs, see instructions ▶

Before you begin: Complete Form 8853, Archer MSAs and Long-Term Care Insurance Contracts, if required.

Part I HSA Contributions and Deduction. See the instructions before completing this part. If you are filing jointly and both you and your spouse each have separate HSAs, complete a separate Part I for each spouse.

1 Check the box to indicate your coverage under a high-deductible health plan (HDHP) during 2010 (see instructions). . . . . . . . . . . . . . . . . . . . . . . . ▶ Self-only Family

2 HSA contributions you made for 2010 (or those made on your behalf), including those made from January 1, 2011, through April 18, 2011, that were for 2010. Do not include employer contributions, contributions through a cafeteria plan, or rollovers (see instructions) . . . . . 2

3 If you were under age 55 at the end of 2010, and on the first day of every month during 2010, you were, or were considered, an eligible individual with the same coverage, enter $3,050($6,150 for family coverage). All others, see the instructions for the amount to enter . . . . 3

4 Enter the amount you and your employer contributed to your Archer MSAs for 2010 from Form 8853, lines 1 and 2. If you or your spouse had family coverage under an HDHP at any timeduring 2010, also include any amount contributed to your spouse’s Archer MSAs . . . . . 4

5 Subtract line 4 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . 5

6 Enter the amount from line 5. But if you and your spouse each have separate HSAs and had family coverage under an HDHP at any time during 2010, see the instructions for the amount to enter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 If you were age 55 or older at the end of 2010, married, and you or your spouse had family coverage under an HDHP at any time during 2010, enter your additional contribution amount (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 Add lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . 8 9 Employer contributions made to your HSAs for 2010 . . . . 9

10 Qualified HSA funding distributions . . . . . . . . . . 10 11 Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Subtract line 11 from line 8. If zero or less, enter -0- . . . . . . . . . . . . . . . 12 13 HSA deduction. Enter the smaller of line 2 or line 12 here and on Form 1040, line 25, or Form

1040NR, line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Caution: If line 2 is more than line 13, you may have to pay an additional tax (see page 5 of the instructions).

Part II HSA Distributions. If you are filing jointly and both you and your spouse each have separate HSAs, complete a separate Part II for each spouse.

14 a Total distributions you received in 2010 from all HSAs (see instructions) . . . . . . . . 14a

b Distributions included on line 14a that you rolled over to another HSA. Also include any excess contributions (and the earnings on those excess contributions) included on line 14a that were withdrawn by the due date of your return (see instructions) . . . . . . . . . . . . 14b

c Subtract line 14b from line 14a . . . . . . . . . . . . . . . . . . . . . . 14c 15 Unreimbursed qualified medical expenses (see instructions) . . . . . . . . . . . . 15

16 Taxable HSA distributions. Subtract line 15 from line 14c. If zero or less, enter -0-. Also, include this amount in the total on Form 1040, line 21, or Form 1040NR, line 21. On the dottedline next to line 21, enter “HSA” and the amount . . . . . . . . . . . . . . . . 16

17 a If any of the distributions included on line 16 meet any of the Exceptions to the Additional 10% Tax (see instructions), check here . . . . . . . . . . . . . . . . . ▶

b Additional 10% tax (see instructions). Enter 10% (.10) of the distributions included on line 16 that are subject to the additional 10% tax. Also include this amount in the total on Form 1040, line 60, or Form 1040NR, line 59. On the dotted line next to Form 1040, line 60, or Form1040NR, line 59, enter “HSA” and the amount . . . . . . . . . . . . . . . . . 17b



Form 8889 (2010) Page 2 Part III Income and Additional Tax for Failure To Maintain HDHP Coverage. See page 6 of the instructions

before completing this part. If you are filing jointly and both you and your spouse each have separate HSAs, complete a separate Part III for each spouse.

18 Qualified HSA distribution . . . . . . . . . . . . . . . . . . . . . . . 18

19 Last-month rule . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

20 Qualified HSA funding distribution . . . . . . . . . . . . . . . . . . . . . 20

21 Total income. Add lines 18, 19, and 20. Include this amount on Form 1040, line 21, or Form 1040NR, line 21. On the dotted line next to Form 1040, line 21, or Form 1040NR, line 21, enter “HSA” and the amount . . . . . . . . . . . . . . . . . . . . . . . . 21

22 Additional tax. Multiply line 21 by 10% (.10). Include this amount in the total on Form 1040, line 60, or Form 1040NR, line 59. On the dotted line next to Form 1040, line 60, or Form 1040NR, line 59, enter “HDHP” and the amount . . . . . . . . . . . . . . . . . . . 22

Form 8889 (2010)


Form 8903(Rev. December 2010) Department of the Treasury Internal Revenue Service

Domestic Production Activities Deduction

▶ Attach to your tax return. ▶ See separate instructions.

OMB No. 1545-1984


Name(s) as shown on return Identifying number

Note. Do not complete column (a), unless you have oil-related production activities. Enter amounts for all activities in column (b), including oil-related production activities.

(a) Oil-related production activities

(b) All activities

1 Domestic production gross receipts (DPGR) . . . . . . . . 1 2 Allocable cost of goods sold. If you are using the small business

simplified overall method, skip lines 2 and 3 . . . . . . . . 2 3 Enter deductions and losses allocable to DPGR (see instructions) . 3 4

If you are using the small business simplified overall method, enter the amount of cost of goods sold and other deductions or losses you ratably apportion to DPGR. All others, skip line 4 . . . . . . . 4

5 Add lines 2 through 4 . . . . . . . . . . . . . . . 5 6 Subtract line 5 from line 1 . . . . . . . . . . . . . . 6 7 Qualified production activities income from estates, trusts, and

certain partnerships and S corporations (see instructions) . . . 7 8 Add lines 6 and 7. Estates and trusts, go to line 9, all others, skip line

9 and go to line 10 . . . . . . . . . . . . . . . . 8 9 Amount allocated to beneficiaries of the estate or trust (see

instructions) . . . . . . . . . . . . . . . . . . 9 10

a

Oil-related qualified production activities income. Estates andtrusts, subtract line 9, column (a), from line 8, column (a), all others, enter amount from line 8, column (a). If zero or less, enter -0- here . 10a

b

Qualified production activities income. Estates and trusts, subtract line 9, column (b), from line 8, column (b), all others, enter amount from line 8, column (b). If zero or less, enter -0- here, skip lines 11through 21, and enter -0- on line 22 . . . . . . . . . . . 10b

11 Income limitation (see instructions):• Individuals, estates, and trusts. Enter your adjusted gross income figured without the domestic production activities deduction . . . . . . . . . . . . . . . . } 11 • All others. Enter your taxable income figured without the domestic production activities deduction (tax-exempt organizations, see instructions) . . . . . . . . . . .

12 Enter the smaller of line 10b or line 11. If zero or less, enter -0- here, skip lines 13 through 21, and enter -0- on line 22 . . . . . . . . . . . . . . . . . . . . . . . . 12

13 Enter 9% of line 12 . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 a Enter the smaller of line 10a or line 12 . . . . . . . . . . 14a

b Reduction for oil-related qualified production activities income. Multiply line 14a by 3% . . 14b15 Subtract line 14b from line 13 . . . . . . . . . . . . . . . . . . . . . . 1516 Form W-2 wages (see instructions) . . . . . . . . . . . . . . . . . . . . 1617 Form W-2 wages from estates, trusts, and certain partnerships and S corporations

(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 1718 Add lines 16 and 17. Estates and trusts, go to line 19, all others, skip line 19 and go to line 20 1819 Amount allocated to beneficiaries of the estate or trust (see instructions) . . . . . . . 1920 Estates and trusts, subtract line 19 from line 18, all others, enter amount from line 18 . . . 2021 Form W-2 wage limitation. Enter 50% of line 20 . . . . . . . . . . . . . . . . 2122 Enter the smaller of line 15 or line 21. . . . . . . . . . . . . . . . . . . . 2223 Domestic production activities deduction from cooperatives. Enter deduction from Form

1099-PATR, box 6 . . . . . . . . . . . . . . . . . . . . . . . . . 2324 Expanded affiliated group allocation (see instructions) . . . . . . . . . . . . . . 2425 Domestic production activities deduction. Combine lines 22 through 24 and enter the result

here and on Form 1040, line 35; Form 1120, line 25; or the applicable line of your return . . 25

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 37712F



Alternative Motor Vehicle Credit▶ See separate instructions. ▶ Attach to your tax return.

OMB No. 1545-1998



Note.• Use this form to claim the credit for certain alternative motor vehicles or plug-in electric vehicle conversions.• Claim the credit for certain two- or three-wheeled or low-speed four-wheeled plug-in electric vehicles on Form 8834.• Claim the credit for certain other plug-in electric vehicles on Form 8936.

Part I Tentative Credit

Use a separate column for each vehicle. If you need more columns, use additional Forms 8910 and include the totals on lines 13 and 17.

(a) Vehicle 1 (b) Vehicle 2 (c) Vehicle 3

1 Year, make, and model of vehicle . . . . . . . 12 Enter date vehicle was placed in service (MM/DD/YYYY) . 2

3 Credit allowable (see instructions for amount to enter) 3 4

If you are not claiming the plug-in conversion credit, skip lines 4 through 8, enter -0- on line 9, and go to line 10. Otherwise, enter the cost of converting the vehicle to a qualified plug-in electric drive motor vehicle . . . .

5 Section 179 expense deduction (see instructions) . . 56 Subtract line 5 from line 4 . . . . . . . . . . 67 Multiply line 6 by 10% (.10) . . . . . . . . . 78 Maximum plug-in conversion credit amount allowable . 8 4,000 00 4,000 00 4,000 009 Enter the smaller of line 7 or line 8 . . . . . . . 9

10 Tentative credit. Add lines 3 and 9 . . . . . . . 10

/ / / / / /

Next: If you did NOT use your vehicle for business or investment purposes and did not have a credit from a partnership or S corporation, skip Part II and go to Part III. All others, go to Part II.

Part II Credit for Business/Investment Use Part of Vehicle

11 Business/investment use percentage (see instructions) . 11 % % %

12 Multiply line 10 by line 11 . . . . . . . . . . 1213 Add columns (a) through (c) on line 12 . . . . . . . . . . . . . . . . . . . . 1314 Alternative motor vehicle credit from partnerships and S corporations . . . . . . . . . . 1415 Business/investment use part of credit. Add lines 13 and 14. Partnerships and S corporations,

report this amount on Schedule K; all others, report this amount on Form 3800, line 1r . . . . 15

Part III Credit for Personal Use Part of Vehicle

16

If you skipped Part II, enter the amount from line 10. If you completed Part II, subtract line 12 from line 10 . 16

17 Add columns (a) through (c) on line 16 . . . . . . . . . . . . . . . . . . . . 1718 Enter the amount from Form 1040, line 46, or Form 1040NR, line 44 . . . . . . . . . . 1819 Personal credits from Form 1040 or 1040NR (see instructions) . . . . . . . . . . . . . 1920 Subtract line 19 from line 18. If zero or less, stop. You cannot claim the personal use part of the

credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2021 Personal use part of credit. Enter the smaller of line 17 or line 20 here and on Form 1040, line 53

(or Form 1040NR, line 50). Check box c on that line and enter “8910” in the space next to that box. If line 20 is smaller than line 17, see instructions . . . . . . . . . . . . . . . 21


ADDITIONAL FORM 8910

4



Alternative Fuel Vehicle Refueling Property Credit


OMB No. 1545-1981



Part I Total Cost of Refueling Property

(a) Hydrogen Refueling Property

(b) Other Refueling Property

1

Total cost of qualified alternative fuel vehicle refueling property placed in service during the tax year . . . . . . . . . . . . . . . 1

Part II Credit for Business/Investment Use Part of Refueling Property

2 Business/investment use part (see instructions) . . . . . . . 2 3 Section 179 expense deduction (see instructions) . . . . . . 3 4 Subtract line 3 from line 2 . . . . . . . . . . . . . . 4 5 Applicable credit rate decimal amount . . . . . . . . . . 56 Multiply line 4 by the applicable decimal amount on line 5 . . . . 67 Maximum business/investment use part of credit (see instructions) . 78 Enter the smaller of line 6 or line 7. . . . . . . . . . . . 89 Add columns (a) and (b) on line 8 . . . . . . . . . . . . . . . . . . . . 9

10 Alternative fuel vehicle refueling property credit from partnerships and S corporations . . . 1011

Business/investment use part of credit. Add lines 9 and 10. Partnerships and S corporations, report this amount on Schedule K; all others, report this amount on Form 3800, line 1s . . . . . 11

Part III Credit for Personal Use Part of Refueling Property

12

Subtract line 2 from line 1. If zero, stop here; do not file this form unless you are claiming a credit on line 11 . . . . . . . . . 12

13 Applicable credit rate decimal amount . . . . . . . . . . 1314 Multiply line 12 by the applicable decimal amount on line 13 . . . 1415 Maximum personal use part of credit (see instructions) . . . . . 1516 Enter the smaller of line 14 or line 15 . . . . . . . . . . 1617 Add columns (a) and (b) on line 16 . . . . . . . . . . . . . . . . . . . . 1718 Regular tax before credits:

• Individuals. Enter the amount from Form 1040, line 44 (or Form 1040NR, line 42) • Other filers. Enter the regular tax before credits from your return . . . . } . . . .

1819 Credits that reduce regular tax before the alternative fuel vehicle refueling property credit:

a Foreign tax credit . . . . . . . . . . . . . . . . 19ab Personal credits from Form 1040 or 1040NR (see instructions) . 19bc Non-business qualified electric vehicle credit from Form 8834, line 29 19cd Add lines 19a through 19c . . . . . . . . . . . . . . . . . . . . . . . 19d

20

Net regular tax. Subtract line 19d from line 18. If zero or less, stop here; do not file this formunless you are claiming a credit on line 11 . . . . . . . . . . . . . . . . . 20

21 Tentative minimum tax (see instructions):• Individuals. Enter the amount from Form 6251, line 33 . . . . . . . .• Other filers. Enter the tentative minimum tax from your alternative minimum tax form or schedule . . . . . . . . . . . . . . . . . . . . .

} . . . 21

22

Subtract line 21 from line 20. If zero or less, stop here; do not file this form unless you are claiming a credit on line 11 . . . . . . . . . . . . . . . . . . . . . . 22

23

Personal use part of credit. Enter the smaller of line 17 or line 22 here and on Form1040, line 53; Form 1040NR, line 50; or the appropriate line of your return. If line 22 is smaller than line 17, see instructions . . . . . . . . . . . . . . . . . . . . . 23

For Paperwork Reduction Act Notice, see instructions. Cat. No. 37721Q Form 8911 (2010)



Tuition and Fees DeductionSee Instructions.

Attach to Form 1040 or Form 1040A.

OMB No. 1545-0074



You cannot take both an education credit from Form 8863 and the tuition and fees deduction from this form for the same student for the same tax year.

Before you begin: ✔ To see if you qualify for this deduction, see Who Can Take the Deduction in the instructions below.✔ If you file Form 1040, figure any write-in adjustments to be entered on the dotted line next to Form

1040, line 36. See the 2010 Form 1040 instructions for line 36.1 (a) Student’s name (as shown on page 1 of your tax return)

First name Last name

(b) Student’s social security number (as shown on page

1 of your tax return)

(c) Qualified expenses (see instructions)

2 Add the amounts on line 1, column (c), and enter the total . . . . . . . . . . . . . 23 Enter the amount from Form 1040, line 22, or Form 1040A, line 15 34 Enter the total from either:

• Form 1040, lines 23 through 33, plus any write-in adjustments entered on the dotted line next to Form 1040, line 36, or

• Form 1040A, lines 16 through 18. . . . . . . . . . . 45 Subtract line 4 from line 3.* If the result is more than $80,000 ($160,000 if married filing jointly),

stop; you cannot take the deduction for tuition and fees . . . . . . . . . . . . . 5*If you are filing Form 2555, 2555-EZ, or 4563, or you are excluding income from Puerto Rico, see Effect of the Amount of Your Income on the Amount of Your Deduction in Pub. 970, chapter 6, to figure the amount to enter on line 5.

6 Tuition and fees deduction. Is the amount on line 5 more than $65,000 ($130,000 if marriedfiling jointly)?

Yes. Enter the smaller of line 2, or $2,000.

No. Enter the smaller of line 2, or $4,000.} . . . . . . . . . . . . . . 6

Also enter this amount on Form 1040, line 34, or Form 1040A, line 19.

Section references are to the Internal Revenue Code unless otherwise noted.

General InstructionsPurpose of FormUse Form 8917 to figure and take the deduction for tuition and fees expenses paid in 2010.

This deduction is based on qualified education expenses paid to an eligible postsecondary educational institution. See What Expenses Qualify, on page 2, for more information.

TIPYou may be able to take the American opportunity credit or lifetime learning credit for your education expenses instead of the tuition and fees deduction. Figure your tax both ways and choose the one that

gives you the lower tax. See Form 8863, Education Credits, and Pub. 970, Tax Benefits for Education, for more information about these credits.

Who Can Take the DeductionYou may be able to take the deduction if you, your spouse, or a dependent you claim on your tax return was a student enrolled at or attending an eligible educational institution. The deduction is based on the amount of qualified education expenses you paid for the student in 2010 for academic periods beginning in 2010 and the first 3 months of 2011.

▲!CAUTION

Qualified education expenses must be reduced by any expenses paid directly or indirectly using tax-free educational assistance. See Tax-free educational assistance and refunds of qualified

education expenses on page 2.

Generally, in order to claim the deduction for qualified education expenses for a dependent, you must have paid the expenses in 2010 and must claim an exemption for the student as a dependent on your 2010 tax return (line 6c of Form 1040 or 1040A). For additional information, see chapter 6 of Pub. 970.

You cannot claim the tuition and fees deduction if any of the following apply.

• Your filing status is married filing separately.

• Another person can claim an exemption for you as a dependent on his or her tax return. You cannot take the deduction even if the other person does not actually claim that exemption.

• Your modified adjusted gross income (MAGI), as figured on line 5, is more than $80,000 ($160,000 if filing a joint return).

• You were a nonresident alien for any part of the year and did not elect to be treated as a resident alien for tax purposes. More information on nonresident aliens can be found in Pub. 519, U.S. Tax Guide for Aliens.


▲!CAUTION

Student 4



Uncollected Social Security and Medicare Tax on Wages

▶ See instructions on back. ▶ Attach to Form 1040, Form 1040NR, Form 1040NR-EZ, Form 1040-SS, or Form 1040-PR.

OMB No. 1545-0074


Name of person who must file this form. If married, complete a separate Form 8919 for each spouse who must file this form. Social security number

Who must file. You must file Form 8919 if all of the following apply.• You performed services for a firm.• The firm did not withhold your share of social security and Medicare taxes from your pay.• Your pay from the firm was not for services as an independent contractor.• One or more of the reasons listed below under Reason codes apply to you.

Reason codes: For each firm listed below, enter the applicable reason code(s) for filing this form in column (c). If none of the reason codes apply to you, but you believe you should have been treated as an employee, enter reason code G, and file Form SS-8 on or before the date you file your tax return.

A I filed Form SS-8 and received a determination letter stating that I am an employee of this firm.

B I was designated as a “section 530 employee” by my employer or by the IRS prior to January 1, 1997.

C I received other correspondence from the IRS that states I am an employee.

D I was previously treated as an employee by this firm and am performing services in a substantially similar capacity and under substantially similar direction and control. (You must also enter reason code G.)

E My co-workers, performing substantially similar services under substantially similar direction and control, are treated as employees. (You must also enter reason code G.)

F My co-workers, performing substantially similar services under substantially similar direction and control, filed Form SS-8 for this firm and received a determination that they were employees. (You must also enter reason code G.)

G I filed Form SS-8 with the IRS and have not received a reply.

(a) Name of firm

(b) Firm’s federal

identification number

(see instructions)

(c) Enter reason

code(s) from above

(d) Date IRS determination or correspondence

was received (MM/DD/YYYY)

(see instructions)

(e) Check if Form

1099-MISC was received

(f) Total wages received with no social security or

Medicare tax withholding and not

reported on Form W-2

1

2

3

4

56 Total wages. Combine lines 1 through 5 in column (f). Enter here and include on Form 1040,

line 7; Form 1040NR, line 8; or Form 1040NR-EZ, line 3 . . . . . . . . . . . . . 6

7 Maximum amount of wages subject to social security tax . . . 7

8

Total social security wages and tips (total of boxes 3 and 7 on Form(s) W-2) or railroad retirement (tier 1) compensation, and unreported tips subject to social security tax from Form 4137, line 10 . . . . . . . . . . . . . . . . . . . . 8

9 Subtract line 8 from line 7. If line 8 is more than line 7, enter -0- here and on line 10 . . . . 910 Wages subject to social security tax. Enter the smaller of line 6 or line 9 . . . . . . . . 1011 Multiply line 10 by .062 (social security tax rate) . . . . . . . . . . . . . . . . 1112 Multiply line 6 by .0145 (Medicare tax rate) . . . . . . . . . . . . . . . . . . 1213 Add lines 11 and 12. Enter here and on Form 1040, line 57; Form 1040NR, line 55; or

Form 1040NR-EZ, line 16. (Form 1040-SS and Form 1040-PR filers, see instructions) . . . ▶ 13For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 37730B Form 8919 (2010)

106,800 00


Form

8936 Department of the Treasury


Qualified Plug-in Electric Drive Motor Vehicle Credit

OMB No. 1545-2137



Part I

Part III


Identifying number

Tentative Credit

Enter date vehicle was placed in service (MM/DD/YYYY)

Tentative credit (see instructions for amount to enter)

Multiply line 3 by line 4

Add columns (a) through (c) on line 5

Qualified plug-in electric drive motor vehicle credit from partnerships and S corporations

Credit for Personal Use Part of Vehicle

2 3

5

2

3

5

(a) Vehicle 1

(b) Vehicle 2

(c) Vehicle 3

Form 8936 (2010)

Cat. No. 37751E

6

6


Year, make, and model of vehicle

1

1

If you skipped Part II, enter the amount from line 3. If youcompleted Part II, subtract line 5 from line 3

9

Business/investment use part of credit. Add lines 6 and 7. Partnerships and S corporations,report this amount on Schedule K; all others, report this amount on Form 3800, line 1y

7

13

14

Personal use part of credit. Enter the smaller of line 10 or line 13 here and on Form 1040, line 53, or Form 1040NR, line 50. Check box c on that line and enter “8936” in the space next to that box.If line 13 is smaller than line 10, see instructions

Subtract line 12 from line 11

12

13

14

7


/ /

/ /

/ /

Business/investment use percentage (see instructions)

4

4

%

%

%

Part II

Credit for Business/Investment Use Part of Vehicle

8 8

11


10

10

12

9


Enter the amount from Form 1040, line 46, or Form 1040NR, line 44

Personal credits from Form 1040 or 1040NR (see instructions)

11

10

Note. ● Use this form to claim the credit for certain plug-in electric vehicles (other than two- or three-wheeled or low-speed

four-wheeled vehicles). ● Claim the credit for certain two- or three-wheeled or low-speed four-wheeled plug-in electric vehicles on Form 8834. ● Claim the credit for certain alternative motor vehicles or plug-in electric vehicle conversions on Form 8910.



Credit for Small Employer Health Insurance Premiums



OMB No. 1545-2198



1 Enter the number of individuals you employed during the tax year who are consideredemployees for purposes of this credit (see instructions) . . . . . . . . . . . . . . 1

2 Enter the number of full-time equivalent employees you had for the tax year (see instructions). Ifyou entered 25 or more, skip lines 3 through 11 and enter -0- on line 12 . . . . . . . . 2

3 Average annual wages you paid for the tax year (see instructions). If you entered $50,000 or more, skip lines 4 through 11 and enter -0- on line 12 . . . . . . . . . . . . . . 3

4 Premiums you paid during the tax year for employees included on line 1 for health insurancecoverage under a qualifying arrangement (see instructions) . . . . . . . . . . . . 4

5

Premiums you would have entered on line 4 if the total premium for each employee equaled theaverage premium for the small group market in which you offered health insurance coverage (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Enter the smaller of line 4 or line 5 . . . . . . . . . . . . . . . . . . . . 6

7 Multiply line 6 by the applicable percentage:• Tax-exempt small employers, multiply line 6 by 25% (.25)• All other small employers, multiply line 6 by 35% (.35) . . . . . . . . . . . . . 7

8 If line 2 is 10 or less, enter the amount from line 7. Otherwise, see instructions . . . . . . 89 If line 3 is $25,000 or less, enter the amount from line 8. Otherwise, see instructions . . . . 9

10 Enter the total amount of any state premium subsidies paid and any state tax credits available to you for premiums included on line 4 (see instructions) . . . . . . . . . . . . . . 10

11 Subtract line 10 from line 4. If zero or less, enter -0- . . . . . . . . . . . . . . . 1112 Enter the smaller of line 9 or line 11 . . . . . . . . . . . . . . . . . . . . 12

13 If line 12 is zero, skip lines 13 and 14 and go to line 15. Otherwise, enter the number ofemployees included on line 1 for whom you paid premiums during the tax year for healthinsurance coverage under a qualifying arrangement (see instructions) . . . . . . . . . 13

14 Enter the number of full-time equivalent employees you would have entered on line 2 if you onlyincluded employees included on line 13 . . . . . . . . . . . . . . . . . . . 14

15 Credit for small employer health insurance premiums from partnerships, S corporations, cooperatives, estates, and trusts (see instructions) . . . . . . . . . . . . . . . 15

16 Add lines 12 and 15. Partnerships and S corporations, stop here and report this amount onSchedule K; all others, go to line 17 . . . . . . . . . . . . . . . . . . . . 16

17 Credit for small employer health insurance premiums included on line 16 from passive activities (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 17

18 Subtract line 17 from line 16 . . . . . . . . . . . . . . . . . . . . . . . 1819 Credit for small employer health insurance premiums allowed for 2010 from a passive activity

(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 1920 Carryback of the credit for small employer health insurance premiums from 2011 . . . . . 20

21 Add lines 18 through 20. Cooperatives, estates, and trusts, go to line 22. Tax-exempt smallemployers, skip lines 22 and 23 and go to line 24. All others, stop here and report this amount on Form 3800, line 29h . . . . . . . . . . . . . . . . . . . . . . . . 21


23 Cooperatives, estates, and trusts, subtract line 22 from line 21. Stop here and report this amount on Form 3800, line 29h . . . . . . . . . . . . . . . . . . . . . . . . 23

24 Enter the amount you paid in 2010 for taxes considered payroll taxes for purposes of this credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 24

25 Tax-exempt small employers, enter the smaller of line 21 or line 24 here and on Form 990-T, line 44f . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 37757S Form 8941 (2010)


22222 Voida Employee’s social security number For Official Use Only �

OMB No. 1545-0008

b Employer identification number (EIN)

c Employer’s name, address, and ZIP code

d Control number

e Employee’s first name and initial Last name Suff.

f Employee’s address and ZIP code

1 Wages, tips, other compensation 2 Federal income tax withheld

3 Social security wages 4 Social security tax withheld

5 Medicare wages and tips 6 Medicare tax withheld

7 Social security tips 8 Allocated tips

9 Advance EIC payment 10 Dependent care benefits

11 Nonqualified plans 12a See instructions for box 12Co d e

12bCo d e

12cCo d e

12dCo d e

13 Statutory employee

Retirement plan

Third-party sick pay

Other

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

Form W-2 Wage and Tax Statement 2010Copy A For Social Security Administration — Send this entire page with Form W-3 to the Social Security Administration; photocopies are not acceptable.


For Privacy Act and Paperwork Reduction Act Notice, see back of Copy D.

Cat. No. 10134D

Do Not Cut, Fold, or Staple Forms on This Page — Do Not Cut, Fold, or Staple Forms on This Page

Other

127Sales of Capital Assets Study



Capital Gains and Losses

▶ Attach to Form 1040 or Form 1040NR. ▶ See Instructions for Schedule D (Form 1040). ▶ Use Schedule D-1 to list additional transactions for lines 1 and 8.

OMB No. 1545-0074










1

2 Enter your short-term totals, if any, from Schedule D-1, line 2 . . . . . . . . . . . . . . . . . 2

3 Total short-term sales price amounts. Add lines 1 and 2 in column (d) . . . . . . . . . . . . . . 3

4 Short-term gain from Form 6252 and short-term gain or (loss) from Forms 4684, 6781, and 8824 . 4 5 Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts from

Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6 Short-term capital loss carryover. Enter the amount, if any, from line 10 of your Capital Loss


7 Net short-term capital gain or (loss). Combine lines 1 through 6 in column (f) . . . . . . . 7

Part II Long-Term Capital Gains and Losses—Assets Held More Than One Year







8

9 Enter your long-term totals, if any, from Schedule D-1, line 9 . . . . . . . . . . . . . . . . . 9

10 Total long-term sales price amounts. Add lines 8 and 9 in column (d). . . . . . . . . . . . . . 10

11 Gain from Form 4797, Part I; long-term gain from Forms 2439 and 6252; and long-term gain or (loss) from Forms 4684, 6781, and 8824 . . . . . . . . . . . . . . . . . . . . 11

12 Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts from Schedule(s) K-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

13 Capital gain distributions. See page D-2 of the instructions . . . . . . . . . . . . . . 13 14 Long-term capital loss carryover. Enter the amount, if any, from line 15 of your Capital Loss


15 Net long-term capital gain or (loss). Combine lines 8 through 14 in column (f). Then go to Part III on the back . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 11338H Schedule D (Form 1040) 2010

sum

sumsum sum

nondeductible loss ST

nondeductible loss LT

sumsum

Transaction code

Asset code

Transaction code

Asset code

128 Sales of Capital Assets Study

Schedule D (Form 1040) 2010 Page 2

Part III Summary

16 Combine lines 7 and 15 and enter the result . . . . . . . . . . . . . . . . . . 16

• If line 16 is a gain, enter the amount from line 16 on Form 1040, line 13, or Form 1040NR, line 14. Then go to line 17 below.

• If line 16 is a loss, skip lines 17 through 20 below. Then go to line 21. Also be sure to complete line 22.

• If line 16 is zero, skip lines 17 through 21 below and enter -0- on Form 1040, line 13, or Form1040NR, line 14. Then go to line 22.

17 Are lines 15 and 16 both gains? Yes. Go to line 18. No. Skip lines 18 through 21, and go to line 22.

18 Enter the amount, if any, from line 7 of the 28% Rate Gain Worksheet on page D-8 of the instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ 18

19 Enter the amount, if any, from line 18 of the Unrecaptured Section 1250 Gain Worksheet on page D-9 of the instructions . . . . . . . . . . . . . . . . . . . . . . . . . ▶ 19

20 Are lines 18 and 19 both zero or blank?

Yes. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete theQualified Dividends and Capital Gain Tax Worksheet in the Instructions for Form 1040, line 44 (or in the Instructions for Form 1040NR, line 42). Do not complete lines 21 and 22 below.

No. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete theSchedule D Tax Worksheet on page D-10 of the instructions. Do not complete lines 21 and 22 below.

21 If line 16 is a loss, enter here and on Form 1040, line 13, or Form 1040NR, line 14, the smaller of:

• The loss on line 16 or • ($3,000), or if married filing separately, ($1,500) } . . . . . . . . . . . . . . . 21 ( )

Note. When figuring which amount is smaller, treat both amounts as positive numbers.

22 Do you have qualified dividends on Form 1040, line 9b, or Form 1040NR, line 10b?

Yes. Complete Form 1040 through line 43, or Form 1040NR through line 41. Then complete theQualified Dividends and Capital Gain Tax Worksheet in the Instructions for Form 1040, line 44 (or in the Instructions for Form 1040NR, line 42). No. Complete the rest of Form 1040 or Form 1040NR.


undeterminable nondeductible


VOID CORRECTED (99)

OMB No. 1545-0145

2010

Form 2439

Notice to Shareholder of Undistributed Long-Term Capital Gains

For calendar year 2010, or other tax year of the regulated investment company (RIC) or the

real estate investment trust (REIT)

beginning , 2010, and

ending , 20

Copy A Attach to

Form 1120-RIC or Form 1120-REIT

For Instructions and Paperwork Reduction Act

Notice, see back of Copies A and D.

Cat. No. 11858E Department of the Treasury - Internal Revenue Service

Name, address, and ZIP code of RIC or REIT

Identification number of RIC or REIT

Shareholder’s identifying number

Shareholder’s name, address, and ZIP code

1a Total undistributed long-term capital gains

1b Unrecaptured section 1250 gain

1c Section 1202 gain 1d Collectibles (28%) gain

2 Tax paid by the RIC or REIT on the box 1a gains

Form 2439


Form 4684Department of theTreasury Internal Revenue Service

Casualties and Thefts▶ See separate instructions. ▶ Attach to your tax return.

▶ Use a separate Form 4684 for each casualty or theft.

OMB No. 1545-0177



SECTION A—Personal Use Property (Use this section to report casualties and thefts of property not used in a trade or business or for income-producing purposes.)


Property A

Property B

Property C


A B C D2 Cost or other basis of each property . . . . . . 2

3 Insurance or other reimbursement (whether or not you filed a claim) (see instructions) . . . . . . . . 3

Note: If line 2 is more than line 3, skip line 4.

4 Gain from casualty or theft. If line 3 is more than line 2, enter the difference here and skip lines 5 through 9 for that column. See instructions if line 3 includes insurance or other reimbursement you did not claim, or you received payment for your loss in a later tax year . . 4



7 Subtract line 6 from line 5 . . . . . . . . . 7


9 Subtract line 3 from line 8. If zero or less, enter -0- . . 9

10 Casualty or theft loss. Add the amounts on line 9 in columns A through D . . . . . . . . . . . . . 10

11 Enter the smaller of line 10 or $100 . . . . . . . . . . . . . . . . . . . . . . . . 11


Caution: Use only one Form 4684 for lines 13 through 21.

13 Add the amounts on line 12 of all Forms 4684 . . . . . . . . . . . . . . . . . . . . . 13

14 Add the amounts on line 4 of all Forms 4684. . . . . . . . . . . . . . . . . . . . . . 14

15 • If line 14 is more than line 13, enter the difference here and on Schedule D. Do not complete the rest of this section (see instructions).

• If line 14 is less than line 13, enter -0- here and go to line 16.

• If line 14 is equal to line 13, enter -0- here. Do not complete the rest of this section.} . . . . . . . 15

16 If line 14 is less than line 13, enter the difference . . . . . . . . . . . . . . . . . . . . 16

17

Does the amount on line 12 include a loss from a disaster declared a federal disaster in tax years beginning after 2007 that occurred before 2010?

Yes. Enter the amount from line 3 of the Worksheet for Line 17, in the instructions. If you are filing Schedule A (Form 1040), go to line 18. Otherwise, enter this amount on Schedule L (Form 1040A or 1040). Do not complete the rest of Section A. Form 1040NR filers, see instructions.

No. Enter -0- and go to line 18 . . . . . . . . . . . . . . . . . . . . . . . . 17


19 Enter 10% of your adjusted gross income from Form 1040, line 38, or Form 1040NR, line 36. Estates and trusts, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

20 Subtract line 19 from line 18. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . 20

21 Add lines 17 and 20. Also enter the result on Schedule A (Form 1040), line 20, or Form 1040NR, Schedule A, line 8. Estates and trusts, enter the result on the “Other deductions” line of your tax return . . . . . . . . . . 21

For Paperwork Reduction Act Notice, see page 5 of the instructions. Cat. No. 12997O Form 4684 (2010)


Form 4684 (2010) Attachment Sequence No. 26 Page 2Name(s) shown on tax return. Do not enter name and identifying number if shown on other side. Identifying number

SECTION B—Business and Income-Producing PropertyPart I Casualty or Theft Gain or Loss (Use a separate Part l for each casualty or theft.)


Property A

Property B

Property C


A B C D23 Cost or adjusted basis of each property . . . . . 23 24 Insurance or other reimbursement (whether or not you

filed a claim). See the instructions for line 3 . . . . 24 Note: If line 23 is more than line 24, skip line 25.

25 Gain from casualty or theft. If line 24 is more than line 23, enter the difference here and on line 32 or line 37, column (c), except as provided in the instructions for line 36. Also, skip lines 26 through 30 for that column. See the instructions for line 4 if line 24 includes insurance or other reimbursement you did not claim, or you received payment for your loss in a later tax year . . . . 25



28 Subtract line 27 from line 26 . . . . . . . . 28

29 Enter the smaller of line 23 or line 28 . . . . . 29

Note: If the property was totally destroyed by casualty or lost from theft, enter on line 29 the amount from line 23.

30 Subtract line 24 from line 29. If zero or less, enter -0- 3031 Casualty or theft loss. Add the amounts on line 30. Enter the total here and on line 32 or line 37 (see instructions) . . 31

Part II Summary of Gains and Losses (from separate Parts l) (b) Losses from casualties or thefts

(a) Identify casualty or theft(i) Trade, business,

rental or royalty property

(ii) Income- producing and

employee property

(c) Gains from casualties or thefts includible in income

Casualty or Theft of Property Held One Year or Less32

( ) ( )

( ) ( )

33 Totals. Add the amounts on line 32 . . . . . . . . . . . . 33 ( ) ( )

34 Combine line 33, columns (b)(i) and (c). Enter the net gain or (loss) here and on Form 4797, line 14. If Form 4797 is not otherwise required, see instructions . . . . . . . . . . . . . . . . . . . . . . . 34

35 Enter the amount from line 33, column (b)(ii) here. Individuals, enter the amount from income-producing property on Schedule A (Form 1040), line 28, or Form 1040NR, Schedule A, line 16, and enter the amount from property used as an employee on Schedule A (Form 1040), line 23, or Form 1040NR, Schedule A, line 11. Estates and trusts, partnerships, and S corporations, see instructions . . . . 35

Casualty or Theft of Property Held More Than One Year36 Casualty or theft gains from Form 4797, line 32 . . . . . . . . . . . . . . . . . . . . . . . . . 36 37 ( ) ( )

( ) ( )

38 Total losses. Add amounts on line 37, columns (b)(i) and (b)(ii) . . . . . 38 ( ) ( )

39 Total gains. Add lines 36 and 37, column (c) . . . . . . . . . . . . . . . . . . . . . . 39

40 Add amounts on line 38, columns (b)(i) and (b)(ii) . . . . . . . . . . . . . . . . . . . . 40

41 If the loss on line 40 is more than the gain on line 39:a Combine line 38, column (b)(i) and line 39, and enter the net gain or (loss) here. Partnerships (except electing large

partnerships) and S corporations, see the note below. All others, enter this amount on Form 4797, line 14. If Form 4797 is not otherwise required, see instructions . . . . . . . . . . . . . . . . . . . . . 41a

b Enter the amount from line 38, column (b)(ii) here. Individuals, enter the amount from income-producing property on Schedule A (Form 1040), line 28, or Form 1040NR, Schedule A, line 16, and enter the amount from property used as an employee on Schedule A (Form 1040), line 23, or Form 1040NR, Schedule A, line 11. Estates and trusts, enter on the “Other deductions” line of your tax return. Partnerships (except electing large partnerships) and S corporations, see the note below. Electing large partnerships, enter on Form 1065-B, Part II, line 11 . . . . . . . . . 41b

42 If the loss on line 40 is less than or equal to the gain on line 39, combine lines 39 and 40 and enter here. Partnerships (except electing large partnerships), see the note below. All others, enter this amount on Form 4797, line 3 . . . . 42

Note: Partnerships, enter the amount from line 41a, 41b, or line 42 on Form 1065, Schedule K, line 11. S corporations, enter the amount from line 41a or 41b on Form 1120S, Schedule K, line 10.

Form 4684 (2010)




Under Sections 179 and 280F(b)(2))▶ Attach to your tax return. ▶ See separate instructions.

OMB No. 1545-0184














sum of (d) and (e)




















SUM SUM SUM SUM

SUM SUM SUM SUM

Asset Code Transaction Code




(see instructions)



A

B

C

D

These columns relate to the properties on lines 19A through 19D. ▶Property A Property B Property C Property D




























(a) Section 179




Form 4797 (2010)




Installment Sale Income▶ Attach to your tax return.

▶ Use a separate form for each sale or other disposition of

property on the installment method.

OMB No. 1545-0228



1 Description of property ▶ 2 a Date acquired (mm/dd/yyyy) ▶ b Date sold (mm/dd/yyyy) ▶

3 Was the property sold to a related party (see instructions) after May 14, 1980? If “No,” skip line 4 . . . . Yes No

4 Was the property you sold to a related party a marketable security? If “Yes,” complete Part III. If “No,” complete Part III for the year of sale and the 2 years after the year of sale . . . . . . . . . . . . Yes No

Part I Gross Profit and Contract Price. Complete this part for the year of sale only.5 Selling price including mortgages and other debts. Do not include interest, whether stated or unstated 5 6 Mortgages, debts, and other liabilities the buyer assumed or took the

property subject to (see instructions) . . . . . . . . . . . 6 7 Subtract line 6 from line 5. . . . . . . . . . . . . . . 7 8 Cost or other basis of property sold . . . . . . . . . . . 8 9 Depreciation allowed or allowable . . . . . . . . . . . . 9

10 Adjusted basis. Subtract line 9 from line 8 . . . . . . . . . 10 11 Commissions and other expenses of sale . . . . . . . . . 11 12 Income recapture from Form 4797, Part III (see instructions) . . . 12 13 Add lines 10, 11, and 12 . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Subtract line 13 from line 5. If zero or less, do not complete the rest of this form (see instructions) 14 15 If the property described on line 1 above was your main home, enter the amount of your excluded

gain (see instructions). Otherwise, enter -0- . . . . . . . . . . . . . . . . . . . 15 16 Gross profit. Subtract line 15 from line 14 . . . . . . . . . . . . . . . . . . . 16 17 Subtract line 13 from line 6. If zero or less, enter -0- . . . . . . . . . . . . . . . . 17 18 Contract price. Add line 7 and line 17 . . . . . . . . . . . . . . . . . . . . 18 Part II Installment Sale Income. Complete this part for the year of sale and any year you receive a payment or have

certain debts you must treat as a payment on installment obligations.19 Gross profit percentage (expressed as a decimal amount). Divide line 16 by line 18. For years after

the year of sale, see instructions . . . . . . . . . . . . . . . . . . . . . . 19 20 If this is the year of sale, enter the amount from line 17. Otherwise, enter -0- . . . . . . . . 20 21 Payments received during year (see instructions). Do not include interest, whether stated or unstated 21 22 Add lines 20 and 21 . . . . . . . . . . . . . . . . . . . . . . . . . . 22 23 Payments received in prior years (see instructions). Do not include

interest, whether stated or unstated . . . . . . . . . . . 23 24 Installment sale income. Multiply line 22 by line 19 . . . . . . . . . . . . . . . . 24 25 Enter the part of line 24 that is ordinary income under the recapture rules (see instructions) . . . 25 26 Subtract line 25 from line 24. Enter here and on Schedule D or Form 4797 (see instructions) . . . 26 Part III Related Party Installment Sale Income. Do not complete if you received the final payment this tax year.27 Name, address, and taxpayer identifying number of related party

28 Did the related party resell or dispose of the property (“second disposition”) during this tax year? . . . . . Yes No

29 If the answer to question 28 is “Yes,” complete lines 30 through 37 below unless one of the following conditions is met. Check the box that applies.a The second disposition was more than 2 years after the first disposition (other than dispositions of

marketable securities). If this box is checked, enter the date of disposition (mm/dd/yyyy) . . . . . ▶

b The first disposition was a sale or exchange of stock to the issuing corporation.c The second disposition was an involuntary conversion and the threat of conversion occurred after the first disposition.d The second disposition occurred after the death of the original seller or buyer.e It can be established to the satisfaction of the Internal Revenue Service that tax avoidance was not a principal purpose for

either of the dispositions. If this box is checked, attach an explanation (see instructions).

30 Selling price of property sold by related party (see instructions) . . . . . . . . . . . . 30 31 Enter contract price from line 18 for year of first sale . . . . . . . . . . . . . . . . 31 32 Enter the smaller of line 30 or line 31 . . . . . . . . . . . . . . . . . . . . . 32 33 Total payments received by the end of your 2010 tax year (see instructions) . . . . . . . . 33 34 Subtract line 33 from line 32. If zero or less, enter -0- . . . . . . . . . . . . . . . 34 35 Multiply line 34 by the gross profit percentage on line 19 for year of first sale . . . . . . . . 35 36 Enter the part of line 35 that is ordinary income under the recapture rules (see instructions) . . . 36 37 Subtract line 36 from line 35. Enter here and on Schedule D or Form 4797 (see instructions) . . . 37For Paperwork Reduction Act Notice, see page 4. Cat. No. 13601R Form 6252 (2010)


Official Use Only



Gains and Losses From Section 1256 Contracts and Straddles


OMB No. 1545-0644



Check all applicable boxes (see instructions). A Mixed straddle election

B Straddle-by-straddle identification election

C Mixed straddle account election

D Net section 1256 contracts loss election

Part I Section 1256 Contracts Marked to Market

(a) Identification of account (b) (Loss) (c) Gain

1

2 Add the amounts on line 1 in columns (b) and (c) . . . . . . . . . . . . 2 ( )

3 Net gain or (loss). Combine line 2, columns (b) and (c) . . . . . . . . . . . . . . . . . 3

4 Form 1099-B adjustments. See instructions and attach schedule . . . . . . . . . . . . . . 4

5 Combine lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Note: If line 5 shows a net gain, skip line 6 and enter the gain on line 7. Partnerships and S corporations, see instructions.

6 If you have a net section 1256 contracts loss and checked box D above, enter the amount of loss to be carried back. Enter the loss as a positive number . . . . . . . . . . . . . . . . . . 6

7 Combine lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 Short-term capital gain or (loss). Multiply line 7 by 40% (.40). Enter here and include on the appropriate line

of Schedule D (see instructions) . . . . . . . . . . . . . . . . . . . . . . . 8 9 Long-term capital gain or (loss). Multiply line 7 by 60% (.60). Enter here and include on the appropriate line

of Schedule D (see instructions) . . . . . . . . . . . . . . . . . . . . . . . 9 Part II Gains and Losses From Straddles. Attach a separate schedule listing each straddle and its components.

Section A—Losses From Straddles



acquired

(c) Date closed out

or sold


(e) Cost or other basis

plus expense of

sale

(f) Loss. If column (e) is more than

(d), enter difference. Otherwise, enter -0-

(g) Unrecognized

gain on offsetting positions

(h) Recognized loss. If column (f) is more

than (g), enter difference.


10

11a Enter the short-term portion of losses from line 10, column (h), here and include on the appropriate line of Schedule D (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 11a ( )

b Enter the long-term portion of losses from line 10, column (h), here and include on the appropriate line of Schedule D (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 11b ( )

Section B—Gains From Straddles



acquired

(c) Date closed out

or sold

(d) Gross

sales price

(e) Cost or other basis plus

expense of sale

(f) Gain. If column (d) is more than (e),

enter difference.


12

13a Enter the short-term portion of gains from line 12, column (f), here and include on the appropriate line of Schedule D (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 13a

b Enter the long-term portion of gains from line 12, column (f), here and include on the appropriate line of Schedule D (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 13b

Part III Unrecognized Gains From Positions Held on Last Day of Tax Year. Memo Entry Only (see instructions)

(a) Description of property (b) Date acquired

(c) Fair market value on last business day of tax year

(d) Cost or other basis as adjusted

(e) Unrecognized gain. If column (c) is more

than (d), enter difference. Otherwise, enter -0-

14

For Paperwork Reduction Act Notice, see page 4. Cat. No. 13715G Form 6781 (2010)

sum sum

sum sum sumsum sum

sum sum sum

sum sum sum

Asset code

Asset code

Asset code

Asset code





OMB No. 1545-1190







3 Date like-kind property given up was originally acquired (month, day, year) . . . . . . 3 MM/DD/YY Y

4 Date you actually transferred your property to other party (month, day, year) . . . . . 4 MM/DD/YY Y

5 Date like-kind property you received was identified by written notice to another party (month, day, year). See instructions for 45-day written identification requirement . . . . . . . 5 MM/DD/YY Y

6 Date you actually received the like-kind property from other party (month, day, year). See instructions 6 MM/DD/YY Y

7 Was the exchange of the property given up or received made with a related party, either directly or indirectly (such as through an intermediary)? See instructions. If “Yes,” complete Part II. If “No,” go to Part III . . Yes No











Asset code

Asset code

(*)

(*)











26 Enter the number from the upper right corner of your certificate of divestiture. (Do not attach a copy of your certificate. Keep the certificate with your records.) . . . . . . . . . . ▶ –

27 Description of divested property ▶

28 Description of replacement property ▶


30 Sales price of divested property (see instructions). . . . . . 30



of sale . . . . . . . . . . . . . . . . . . . . 33






138 Information Returns Match Study

22222 a Employe s social security number OMB No. 1545-0008

b Employer identification number (EIN)

c Employer’s name, address, and ZIP code

d Control number

e Employee’s first name and initial Last nam Suff.

f Employee’s address and ZIP code

1 Wages, tips, other compensation 2 Federal income tax withheld

3 Social security wages 4 So al security tax withheld

5 Me care wages and tips 6 Me icare tax withheld

7 Soc l security tips 8 All ated tips

9 Adv nce EIC payment 10 Dependent care benefits

11 Nonqualified plans 12a Co d e

12bCo d e

12cCo d e

12dCo d e

13 Statutory employee

Retirement plan

Third-party sick pay

14 Other

15 State Employer’s state ID number 16 State wages, tips, etc. 17 State income tax 18 Local wages, tips, etc. 19 Local income tax 20 Locality name

Form W-2 Wage and Tax Statement 2010


Copy 1—For State, City, or Local Tax Department

R

S

T

V

QW

Y

Z

X (*)

X (*)

X (*)

X (*)

AA

BB

CC

139Information Returns Match Study

OMB No. 1545-0238

2010Form W-2G

Certain Gambling Winnings

This information is being furnished to

the Internal Revenue Service.

Copy B Report this income on your

federal tax return. If this form shows federal income

tax withheld in box 2, attach this copy to your return.

CORRECTED (if checked)PAYER’S name, address, ZIP code, federal identification number, and telephone number

WINNER’S name, address (including apt. no.), and ZIP code

1 Gross winnings 2 Federal income tax withheld

3 Type of wager 4 Date won

5 Transaction 6 Race

7 Winnings from identical wagers 8 Cashier

9 Winner’s taxpayer identification no. 10 Window

11 First I.D. 12 Second I.D.

13 State/Payer’s state identification no. 14 State income tax withheld

Under penalties of perjury, I declare that, to the best of my knowledge and belief, the name, address, and taxpayer identification number that I have furnished correctly identify me as the recipient of this payment and any payments from identical wagers, and that no other person is entitled to any part of these payments.

Signature � Date �

Form W-2G Department of the Treasury - Internal Revenue Service


CORRECTED (if checked)RECIPIENT’S/LENDER’S name, address, and telephone number

MortgageInterest

Statement

1PAYER’S social security numberRECIPIENT’S federal identification no. Mortgage interest received from payer(s)/borrower(s)*

$PAYER’S/BORROWER’S name Points paid on purchase of principal residence2

$Street address (includ g apt. no.) 3

City, state, and ZIP c e

Account number (see structions)

Department of the Treasury - Internal Revenue ServiceForm 1098

Copy B

(keep for your records)

* Caution: The amount shownmay not be fully deductible by you.Limits based on the loan amountand the cost and value of thesecured property may apply. Also,you may only deduct interest tothe extent it was incurred by you,actually paid by you, and notreimbursed by another person.

The information in boxes 1,2, 3, and 4 is important tax

information and is beingfurnished to the Internal

Revenue Service. If you arerequired to file a return, a

negligence penalty or othersanction may be imposed on

you if the IRS determinesthat an underpayment of tax

results because youoverstated a deduction for

this mortgage interest or forthese points or because youdid not report this refund of

interest on your return.

Refund of overpaid interest

For Payer/Borrower

OMB No. 1545-0901

Form 1098

4

5

$Mortgag insurance premiums

$

10


CORRECTED (if checked)

Copy B

For Donor

In order to takea deduction of

more than $500for this

contribution, youmust attach this

copy to yourfederal tax

return.

Unless box 5a or5b is checked,your deductioncannot exceedthe amount in

box 4c.

Contributions ofMotor Vehicles,

Boats, andAirplanes

AttachmentSequence No. 155AOMB No. 1545-1959DONEE’S name, street address, city, state, ZIP code, and telephone no.

DONOR’S identificationnumber

DONEE’S federal identificationnumber

DONOR’S name

Street address (including apt. no.)

City, state, and ZIP code

3

Donee certifies that vehicle was sold in arm’slength transaction to unrelated party

Form 1098-C

1

Make, model, and year of vehicle2

Gross proceeds from sale (see instructions)

4a

Donee certifies that vehicle is to be transferred to a needy individual for significantly below fair market value in furtherance ofdonee’s charitable purpose

4c

Vehicle or other identification number

Date of contribution

5b

$

Date of sale4b

Donee certifies that vehicle will not be transferred for money, other property, or services before completion of materialimprovements or significant intervening use

Donee certifies the following detailed description of material improvements or significant intervening use and duration of use

5a

5c

6b

6c

Value of goods and services provided in exchange for the vehicle

Describe the goods and services, if any, that were provided. If this box is checked, donee certifies that the goods and servicesconsisted solely of intangible religious benefits �

Did you provide goods or services in exchange for the vehicle? �6a Yes No

$

Department of the Treasury - Internal Revenue ServiceForm 1098-C

7 Under the law, the donor may not claim a deduction of more than $500 for this vehicle if this box is checked �

10


Copy B


This is important taxinformation and is beingfurnished to the InternalRevenue Service. If you

are required to file areturn, a negligence

penalty or other sanctionmay be imposed on you if

the IRS determines thatan underpayment of tax

results because youoverstated a deduction

for student loan interest.

For Borrower

CORRECTED (if checked)OMB No. 1545-1576RECIPIENT’S/LENDER’S name, address, and telephone number

StudentLoan Interest

Statement

1BORROWER’S social security numberRECIP NT’S federal identification no. Student loan interest received by lender

$BORROWER’S name



Account number (see instructions)

Department of the Treasury - Internal Revenue ServiceForm 1098-E

Form 1098-E

2 If checked, box 1 does not include loanorigination fees and/or capitalized interest forloans made before September 1, 2004

10


CORRECTED

TuitionStatement


Copy BFor Student

This is importanttax information

and is beingfurnished to the

Internal RevenueService.

FILER’S name, street address, city, state, ZIP code, and telephone number

3STUDENT’S social security numberFILER’S federal identification no.


2


9Service Provider/Acct. No. (see instr.)

STUDENT’S name

Department of the Treasury - Internal Revenue ServiceForm 1098-T

10

Form 1098-T

OMB No. 1545-1574

Ins. contract reimb./refund

If this box is checked, your educational institutionhas changed its reporting method for 2010

Amounts billed forqualified tuition andrelated expenses

Payments received forqualified tuition andrelated expenses

1

$

$

4 Adjustments made for aprior year

6 Adjustments toscholarships or grantsfor a prior year

$7

$

5 Scholarships or grants

$Checked if the amountin box 1 or 2 includesamounts for anacademic periodbeginning January -March 2011 �

8 Checked if at least

half-time student

Checked if a

graduate student $

10


Copy BFor Recipient

This is important taxinformation and is

being furnished to theInternal Revenue

Service. If you arerequired to file a return,a negligence penalty orother sanction may beimposed on you if thisincome is taxable and

the IRS determines thatit has not been

reported.

OMB No. 1545-0715PAYER’S name, street address, city, state, ZIP code, and telephone no. Date of sale or exchange1a Proceeds FromBroker and

Barter ExchangeTransactionsCUSIP no.1b

Stocks, bonds, etc.2 Reportedto IRS

Gross proceeds

$ Gross proceeds less commissions and option premiums

PAYER’S federal identification number RECIPIENT’S identification number Bartering3 Federal income tax withheld4

$ $RECIPIENT’S name No. of shares exchanged5

Street address (including apt. no.) Description7



Department of the Treasury - Internal Revenue ServiceForm 1099-B

�



Form 1099-B

8

$

Profit or (loss) realized in2010

9 Unrealized profit or (loss) onopen contracts—12/31/2009

10 Unrealized profit or (loss) onopen contracts–12/31/2010

11 Aggregate profit or (loss)

$

$$

Classes of stockexchanged

6

CORPORATION’S name

12 If the box is checked, the recipient cannot take a loss ontheir tax return based on the amount in box 2

10



DEBTOR’S identification numberCREDITOR’S federal identification number

DEBTOR’S name




Form 1099-C Department of the Treasury - Internal Revenue Service

Copy BFor Debtor



penalty or othersanction may be

imposed on you iftaxable income results

from this transactionand the IRS determines

that it has not beenreported.


6 7Bankruptcy (if checked) Fair market value of property

$

4 Debt description

5 Was borrower personally liable for repayment of the debt?

Yes No

OMB No. 1545-1424CREDITOR’S name, street address, city, state, ZIP code, and telephone no.

Cancellationof Debt

Amount of deb canceled2

1 Date canceled

$ Form 1099-C

10Interest if included in box 23

$



Copy BFor Shareholder




imposed on you iftaxable income results

from this transactionand the IRS determines

that it has not beenreported.

(keep for your records)Form 1099-CAP Department of the Treasury - Internal Revenue Service

Changes inCorporate

Control andCapital Structure

OMB No. 1545-1814CORPORATION’S name, street address, city, state, ZIP code, and telephone no.

2

1

SHAREHOLDER’S identification no.CORPORATION’S federal identification no.

SHAREHOLDER’S name

Street address (including ap no.)


Form 1099-CAP

5

Date of sale or exchange

Aggregate amount c’d*


No. of shares exchanged3

* You cannot claim a loss based on the amount in box 2.

$Classes of stock exchanged4

10


CORRECTED (if checked)PAYER’S name, street address, city, state, ZIP code, and telephone no.

RECIPIENT’S identificationnumber

PAYER’S federal identificationnumber

RECIPIENT’S name




Dividends andDistributions

Department of the Treasury - Internal Revenue ServiceForm 1099-DIV (keep for your records)

Copy B


being furnished to the Internal Revenue

Service. If you arerequired to file a

return, a negligence penalty or other

sanction may beimposed on you if

this income is taxableand the IRS

determines that it hasnot been reported.

For Recipient

Unrecap. Sec. 1250 gain

OMB No. 1545-0110Total ordinary dividends1a

$1b Qualified dividends

$Total capital gain distr.2a

3

$5 Investment expenses

Noncash uidation distributionsCash liquidation distributions

$

2b

$ $

Form 1099-DIV

98

$

$4 Federal income tax withheld

10

Collectibles (28%) gainSection 1202 gain2c 2d

$ $Nondividend distributions

6

$

Foreign tax paid 7 Foreign country or U.S. possession

$


CORRECTED (if checked)PAYER’S name, street address, city, state, ZIP code, and telephone no.

CertainGovernment

Payments

PAYER’S federal identification number RECIPIENT’S identification number

RECIPIENT’S name




Department of the Treasury - Internal Revenue ServiceForm 1099-G

Copy B



Service. If you arerequired to file a return,a negligence penalty orother sanction may beimposed on you if thisincome is taxable and

the IRS determines thatit has not been

reported.


For Recipient

OMB No. 1545-0120Unemployment compensation1

$State or local income taxrefunds, credits, or offsets

2

$Federal income tax withheld4Box 2 amount is for tax year

$Taxable energy grants6

$8 Check if box 2 is

trade or businessincome �

Agriculture payments7

$

Form 1099-G

5 ATAA payments

$

10

Market gain9

$State10a State identification no.10b State income tax withheld11

3



Department of the Treasury - Internal Revenue ServiceForm 1099-H

Health Coverage Tax Credit (HCTC)

Advance Payments

Copy BFor Recipient

This is importanttax information

and is beingfurnished to the



ISSUER’S/PROVIDER’S name, street address, city, state, ZIP code, andtelephone no.

OMB No. 1545-1813Amount of HCTC advance payments

1

$

No. of mos. for whichHCTC payments received

2

ISSUER’S/PROVIDER’S federal identification no. RECIPIENT’S identification number

RECIPIENT’S name



Form 1099-HJan.

$

July

Feb.

Mar.

Apr.

May

$

$

$

$

Aug.

Sept.

Oct.

Nov.

$

$

$

$

$Dec.June

$$

9

10

11

12

13

14

3

4

5

6

7

8

10


CORRECTED (if checked)Payer’s RTN (optional)PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0112

Interest Income

PAYER’S federal identification number RECIPIENT’S identification number

RECIPIENT’S name




Department of the Treasury - Internal Revenue ServiceForm 1099-INT

Copy BFor RecipientThis is important tax

information and is beingfurnished to the Internal

Revenue Service. If you arerequired to file a return, a

negligence penalty or othersanction may be imposed

on you if this income istaxable and the IRS

determines that it has notbeen reported.


Form 1099-INTInterest on U.S. Savings Bonds and Treas. obligations3

$Federal income tax withheld Investment expenses54

$$Foreign tax paid6

$7

Early wi drawal penalty2

$

Interest income1

$ 10

Specified private activity bond interest9Tax-exempt interest8

$10 Tax-exempt bond CUSIP no. (see instructions)

$

Foreign country or U.S. possession


CORRECTED (if checked)OMB No. 1545-1519

Long-Term Care andAccelerated Death

Benefits

PAYER’S federal identification number POLICYHOLDER’S identification number

Gross long-term carebenefits paid

1

Copy B

POLICYHOLDER’S name

Accelerated deathbenefits paid





imposed on you if thisitem is required to bereported and the IRS




Department of the Treasury - Internal Revenue ServiceForm 1099-LTC

PAYER’S name, street address, city, state, ZIP code, and telephone no.

2

3


For Policyholder

Form 1099-LTC

Perdiem

Reimbursedamount

INSURED’S social security no.

INSURED’S name



Date certified

$

$

Terminally ill

Chronically ill5Qualified contract(optional)

4 (optional)

10


1211

Nonemployee compensation

CORRECTEDVOIDOMB No. 1545-0115Rents1PAYER’S name, street address, city, state, ZIP code, and telephone no.

$2 Royalties

$Federal income tax withheldOther income3

RECIPIENT’S identificationnumber

PAYER’S federal identificationnumber

5 Fishing boat proceeds 6 Medical and health care payments

$ $RECIPIENT’S name Substitute payments in lieu of

dividends or interest87

$$9Street address (including apt. no.) 10 Crop insurance proceeds


Gross proceeds paid toan attorney

14Excess golden parachutepayments

13Account number (see instructions)

$16 State tax withheld 17 State/Payer’s state no.

$Department of the Treasury - Internal Revenue Service

18 State income

$

$$ $

4

$ $

Payer made direct sales of$5,000 or more of consumerproducts to a buyer(recipient) for resale �

Form 1099-MISC

Form 1099-MISC

MiscellaneousIncome

Copy 1For State Tax

Department

$Section 409A income15bSection 409A deferrals15a

$ $

10


CORRECTED (if checked)OMB No. 1545-0117PAYER’S name, street address, city, state, ZIP code, and telephone no. Original issue discount

for 2010*1

Original IssueDiscountOther periodic interest2

RECIPIENT’S identification numberPAYER’S federal identification number Federal income tax withheld4Early withdrawal penalty3

RECIPIENT’S name




Department of the Treasury - Internal Revenue ServiceForm 1099-OID

$

$

$ $Copy B




return, a negligencepenalty or other

sanction may beimposed on you if thisincome is taxable and

the IRS determinesthat it has not been

reported.


* This may not be the correct figure to report on yourincome tax return. See instructions on the back.

For Recipient

Form 1099-OID

Original issue discount on U.S. Treasury obligations*

5

Investment expenses

6

Description

7

$

$

10


CORRECTED (if checked)PAYER’S name, street address, city, state, ZIP code, and telephone no. OMB No. 1545-0118Patronage dividends1

$ TaxableDistributions

Received FromCooperatives

Nonpatronage distributions2

$Per-unit retain allocations3

$PAYER’S federal identification number RECIPIENT’S identification number Federal income tax withheld4

$Redemption of nonqualifiednotices and retain allocations

5RECIPIENT’S name

$Investment credit7Street address (including apt. no.)

$8City, state, and ZIP code

$Account number (see instructions)

Department of the Treasury - Internal Revenue ServiceForm 1099-PATR

Copy B

This is importanttax information and isbeing furnished to the

Internal RevenueService. If you are

required to file areturn, a negligence


imposed on you if thisincome is taxable and


reported.


For Recipient

Form 1099-PATR

9 Patron’s AMT adjustment

$

Domestic production activitiesdeduction

6

$

10

$Other credits and deductions

Work opportunity credit

10



3RECIPIENT’S social security number

RECIPIENT’S name

2




Department of the Treasury - Internal Revenue ServiceForm 1099-Q

Form 1099-Q

OMB No. 1545-1760

Basis

Earnings

Gross distribution1

$

$

$5

Copy B





return, a negligencepenalty or other

sanction may beimposed on you if thisincome is taxable and


reported.

For Recipient6 If this box is checked,

the recipient is notthe designatedbeneficiary

4 Trustee-to-trusteetransfer

PAYER’S/TRUSTEE’S name, street address, city, state, ZIP code, and telephone number Payments FromQualified

EducationPrograms

(Under Sections529 and 530)

PAYER’S/TRUSTEE’S federal identification no.

Private State

● Coverdell ESA

Check one:● Qualified tuition program—

or

If the fair market value (FMV) is shown below, see Pub. 970,Tax Benefits for Education, for how to figure earnings.

10


VOID CORRECTEDPAYER’S name, street address, city, state, and ZIP code

PAYER’S federal identification number

RECIPIENT’S identification number

RECIPIENT’S name


City, state, a ZIP code

1st year of desig. Roth contrib.


1 Gross distribution

$2a Taxable amount

$

OMB No. 1545-0119

2010Form 1099-R

Distributions From Pensions, Annuities,

Retirement or Profit-Sharing

Plans, IRAs, Insurance

Contracts, etc.

2b Taxable amount not determined

Total distribution

3 Capital gain (included in box 2a)

$

4 Federal income tax withheld

$

Copy 1 For

State, City, or Local

Tax Department

5 Employee contributions /Designated Roth contributions or insurance premiums

$

6 Net unrealized appreciation in employer’s securities

$7 Distribution code(s)

IRA/ SEP/

SIMPLE

8 Other

$ %

9a Your percentage of total distribution %

9b Total employee contributions

$10 State tax withheld

$$

11 State/Payer’s state no. 12 State distribution

$$

13 Local tax withheld

$$

14 Name of locality 15 Local distribution

$$

Form 1099-R Department of the Treasury - Internal Revenue Service



Copy B




imposed on you if thisitem is required to bereported and the IRS



For Transferor

OMB No. 1545-0997

Proceeds From RealEstate Transactions

FILER’S federal identification number TRANSFEROR’S identification number

Gross proceeds

Date of closing1

TRANSFEROR’S name

Address or legal description


City, state, and ZIP code Transferor received or will receive property or servicesas part of the consideration (if checked) �

Account or escrow number (see instructions)

Department of the Treasury - Internal Revenue ServiceForm 1099-S

FILER’S name, street address, city, state, ZIP code, and telephone no.

2

3

4

$ Form 1099-S

Buyer’s part of real estate tax5

$

10


CORRECTED (if checked)OMB No. 1545-1517

Gross distribution1

TRUSTEE’S/PAYER’S name, street address, city, state, and ZIP code

Copy BRECIPIENT’S identification numberPAYER’S federal identification number

$ $RECIPIENT’S name


Department of the Treasury - Internal Revenue ServiceForm 1099-SA

Form 1099-SA

ForRecipient

This informationis being furnished

to the InternalRevenue Service.

3 Distribution code


2 Earnings on excess cont.

4 FMV on date of death

DistributionsFrom an HSA,

Archer MSA, orMedicare Advantage

MSA

$5 HSA

ArcherMSA

MAMSA



10


Page 20 of 31 of Publication 915 10:31 - 16-NOV-2010

The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

FORM SSA-1099 – SOCIAL SECURITY BENEFIT STATEMENT

2010 ● PART OF YOUR SOCIAL SECURITY BENEFITS SHOWN IN BOX 5 MAY BE TAXABLE INCOME.● SEE THE REVERSE FOR MORE INFORMATION.

Box 1. Name Box 2. Benef iary’s Social Security Number

3. Benefits Paid in 2010 Box 4. Benefits Repaid to SSA in 2010 Box 5. Net Benefits for 2010 (Box 3 minus Box 4)

DESCRIPTION OF AMOUNT IN BOX 3 DESCRIPTION OF AMOUNT IN BOX 4

Box 7. Address

Box 8. Claim Number (Use this number if you need to contact SSA.)

Form SSA-1099-SM (1-2011) DO NOT RETURN THIS FORM TO SSA OR IRS

Box 6. Voluntary Federal Income Tax Withheld

Workman's Comp Offset

SSA/RRB indicator

Retire/disable indicator



Copy BFor

Participant

(if checked)

This informationis being

furnished tothe Internal

RevenueService.

CORRECTED

IRAContributionInformation

SIMPLE contributions

OMB No. 1545-0747IRA contributions (otherthan amounts in boxes2-4, 8-10, 13a, and 14a)

1TRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code

$2 Rollover contributions

$Recharacterized contributionsRoth IRA conversion

amount3

PARTICIPANT’S social securitynumber

TRUSTEE’S or ISSUER’S federalidentification no.

5 Fair market value of account 6 Life insurance cost included inbox 1

$ $PARTICIPANT’S name

SEP contributions8

7

$9


Year13bPostponed contribution13aCity, state, and ZIP code

$

14a Repayments

4

$ $

Form 5498

Department of the Treasury - Internal Revenue ServiceForm 5498

11


IRA SEP SIMPLE Roth IRA

If checked, required minimumdistribution for 2011.

RMD amount

Code

$Roth IRA contributions10

12a RMD date 12b

$13c

10

Code14b

$

$


Page 3 of 6 of Form 5498-ESA 8The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

CORRECTEDCoverdell ESA contributionsTRUSTEE’S or ISSUER’S name, street address, city, state, and ZIP code 1

$Rollover contributions2

$BENEFICIARY’S social security numberTRUSTEE’S/ISSUER’S federal identification no.

BENEFICIARY’S name




Department of the Treasury - Internal Revenue ServiceForm 5498-ESA

Form 5498-ESA

OMB No. 1545-1815 Coverdell ESAContributionInformation

Copy BFor Beneficiary

The informationin boxes 1 and 2

is being furnishedto the Internal

Revenue Service.


10



ForParticipant

Copy B

The informationin boxes 1 through

6 is beingfurnished to the


Employee or self-employed person’sArcher MSA contributions made in2010 and 2011 for 2010

TRUSTEE’S name, street address, city, state, and ZIP code 1

$

Rollover contributions4

$

PARTICIPANT’S social security numberTRUSTEE’S federal identification number

Fair market value of HSA,Archer MSA, or MA MSA

5

$

PARTICIPANT’S name




Department of the Treasury - Internal Revenue ServiceForm 5498-SA (keep for your records)

Form 5498-SA

OMB No. 1545-1518

Total contributions madein 2010

2

Total HSA or Archer MSA contributions made in 2011 for 20103

$

$

HSA6

HSA, Archer MSA, orMedicare Advantage

MSA Information

ArcherMSAMAMSA

10


Schedule K-1 (Form 1041) Department of the Treasury Internal Revenue Service

2010For calendar year 2010,

or tax year beginning , 2010,

and ending , 20

Beneficiary’s Share of Income, Deductions, Credits, etc. � See back of form and instructions.

Final K-1 Amended K-1

661110 OMB No. 1545-0092

Information About the Estate or Trust Part I A Estate’s or trust’s employer identification number

B Estate’s or trust’s name

C Fiduciary's name, address, city, state, and ZIP code

D Check if Form 1041-T was filed and enter the date it was filed

E Check if this is the final Form 1041 for the estate or trust

Information About the BeneficiaryPart II F Beneficiary's identifying number

G Beneficiary's name, address, city, state, and ZIP code

H Domestic beneficiary Foreign beneficiary

Beneficiary’s Share of Current Year Income, Deductions, Credits, and Other Items

Part III

1 Interest income

2a Ordinary dividends

2b Qualified dividends

3 Net short-term capital gain

4a Net long-term capital gain

4b 28% rate gain

4c Unrecaptured section 1250 gain

5 Other portfolio and nonbusiness income

6 Ordinary business income

7 Net rental real estate income

8 Other rental income

9 Directly apportioned deductions

10 Estate tax deduction

11 Final year deductions

12 Alternative minimum tax adjustment

13 Credits and credit recapture

14 Other information

*See attached statement for additional information.

Note. A statement must be attached showing the beneficiary’s share of income and directly apportioned deductions from each business, rental real estate, and other rental activity.

For

IRS

Use

Onl

y

For Paperwork Reduction Act Notice, see the Instructions for Form 1041. Cat. No. 11380D Schedule K-1 (Form 1041) 2010


651110 Final K-1 Amended K-1 OMB No. 1545-0099

Schedule K-1 (Form 1065) 2010Department of the Treasury Internal Revenue Service

For calendar year 2010, or tax

year beginning , 2010

ending , 20

Partner’s Share of Income, Deductions, Credits, etc. See back of form and separate instructions.

Information About the Partnership Part I A Partnership’s employer identification umber

B Partnership’s name, address, city, state, and ZIP code

C IRS Center where partnership filed return

D Check if this is a publicly traded partnership (PTP)

Information About the Partner Part II E Partner’s identifying number

F Partner’s name, address, city, state, and ZIP code

G General partner or LLC member-manager

Limited partner or other LLC member

H Domestic partner Foreign partner

I What type of entity is this partner?

J Partner’s share of profit, loss, and capital (see instructions): Beginning Ending

Profit % %

Loss % %

Capital % %

K Partner’s share of liabilities at year end:

Nonrecourse . . . . . . $

Qualified nonrecourse financing . $

Recourse . . . . . . . $

L Partner’s capital account analysis:

Beginning capital account . . . $

Capital contributed during the year $

Current year increase (decrease) . $

Withdrawals & distributions . . $ ( )

Ending capital account . . . . $

Tax basis GAAP Section 704(b) book

Other (explain)

M Did the partner contribute property with a built-in gain or loss?

Yes No

If "Yes", attach statement (see instructions)

Partner’s Share of Current Year Income, Deductions, Credits, and Other Items

Part III

1 Ordinary business income (loss)

2 Net rental real estate income (loss)

3 Other net rental income (loss)

4 Guaranteed payments

5 Interest income



7 Royalties

8 Net short-term capital gain (loss)

9a Net long-term capital gain (loss)

9b Collectibles (28%) gain (loss)


10 Net section 1231 gain (loss)

11 Other income (loss)

12 Section 179 deduction

13 Other deductions

14 Self-employment earnings (loss)

15 Credits

16 Foreign transactions

17 Alternative minimum tax (AMT) items

18 Tax-exempt income and nondeductible expenses

19 Distributions


*See attached statement for additional information.

For

IRS

Use

Onl

y

For Paperwork Reduction Act Notice, see Instructions for Form 1065. Cat. No. 11394R Schedule K-1 (Form 1065) 2010



Schedule K-1 (Form 1120S) Department of the Treasury Internal Revenue Service

2010For calendar year 2010, or tax


ending , 20

Shareholder’s Share of Income, Deductions, Credits, etc. ▶ See back of form and separate instructions.

Information About the Corporation Part I

A Corporation’s employer identification number

B Corporation’s name, address, city, state, and ZIP code

C IRS Center where corporation filed return

Information About the Shareholder Part II

D Shareholder’s identifying number

E Shareholder’s name, address, city, state, and ZIP code

F Shareholder’s percentage of stock ownership for tax year . . . . . . %

For

IRS

Use

Onl

y

Shareholder’s Share of Current Year Income, Deductions, Credits, and Other Items

Part III




4 Interest income



6 Royalties








12 Other deductions

13 Credits



16 Items affecting shareholder basis


* See attached statement for additional information.

For Paperwork Reduction Act Notice, see Instructions for Form 1120S. Cat. No. 11520D Schedule K-1 (Form 1120S) 2010

167


Changes to Special Studies Branch Programs

Estate and Gift Programs

Form 706, Estate Study

The 2010 form is still being drafted. Changes will be determined in summer 2011.

Form 706-NA, Nonresident Alien Estate Tax Study

There are no changes to the SOI Study for Tax Year 2010.

Form 709, Gift Study

There are no changes to the SOI Study for Tax Year 2010.

Tax-Exempt Organizations Programs

Form 990, 990-EZ, Exempt Organization Study

Additional data from Schedule H, Part V are being captured for 2010.

Form 990-PF, Private Foundation Study

There are no changes to the SOI study for Tax Year 2010.

Form 990-T, Exempt Organization Business Income Tax Return Study

On Part IV, a new line item has been added to capture credits for small employer health insurance premiums reported on Form 8941.

Form 4720, Excise Tax Study

There are no changes to the SOI study for 2010.

Form 5227, Split Interest Trust Information Return


168



Tax-Exempt Bonds Programs

Form 8038, Tax-Exempt Private Activity Bond Study


Form 8038-G, Tax-Exempt Governmental Obligations Study

There are no changes to the SOI study for 2010.

Form 8038-B, Build America Bonds and Recovery Zone Economic Development Bonds Study

SOI will be editing essentially all data items from this form, which is new for 2010.

Form 8038-CP, Return for Credit Payments to Issuers of Qualified Bonds

On Part II, checkboxes have been added to line 17. Part III has been expanded to include additional tax credit bonds for the SOI study for 2010.

Form 8038-TC, Return for Tax Credit Bonds and Specified Tax Credit Bonds

SOI will be editing essentially all data items from this form, which is new for 2010.

International Special Studies Programs

Form 1042S, Foreign Persons’ U.S. Income

There are no changes from the 2009 study.

Form 1118, Foreign Tax Credit—Corporations

One item has been added to Schedule B, Part 2.

Form 1120-IC-DISC, Interest Charge Domestic International Sales Corporations

Data from Form 8404, Interest Charge on DISC-Related Tax Liability, are now edited for the study.

Form 3520, Annual Return to Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts

There are no substantial changes from the 2006 study.

169



International Special Studies Programs—continued

Form 3520-A, Annual Information Return of Foreign Trusts With a U.S. Owner


Form 5471, Controlled Foreign Corporations


Form 5713, International Boycotts


Form 8288, Statement of Withholding on Dispositions by Foreign Persons of U.S. Real Property Interests


Form 8805, Partnership Withholding


Form 8832, Entity Classification Elections


Form 8858, Disregarded Entities


171Estate and Gift Programs

United States Estate (and Generation-SkippingTransfer) Tax Return

706Form

OMB No. 1545-0015(Rev. September 2009)

Estate of a citizen or resident of the United States (see separate instructions).Department of the TreasuryInternal Revenue Service

Decedent’s last name1b Decedent’s Social Security No.2Decedent’s first name and middle initial (and maiden name, if any)1a

3b Year domicile established 4 Date of birth Date of death53a County, state, and ZIP code, or foreign country, of legalresidence (domicile) at time of death

Name of executor (see page 5 of the instructions)6a

Executor’s address (number and street including apartment or suite no.; city, town,or post office; state; and ZIP code) and phone no.

6b

Executor’s social security number (see page 5 of the instructions)6c

Name and location of court where will was probated or estate administered7a 7b Case number

If decedent died testate, check here � and attach a certified copy of the will.8 If you extended the time to file this Form 706, check here �9

Par

t 1—

Dec

eden

t an

d E

xecu

tor

If Schedule R-1 is attached, check here �10

11 Total gross estate less exclusion (from Part 5—Recapitulation, page 3, item 12)22 Tentative total allowable deductions (from Part 5—Recapitulation, page 3, item 22)

3a3a Tentative taxable estate (before state death tax deduction) (subtract line 2 from line 1)

4 Adjusted taxable gifts (total taxable gifts (within the meaning of section 2503) made by the decedentafter December 31, 1976, other than gifts that are includible in decedent’s gross estate (section 2001(b))) 4

55 Add lines 3c and 46Tentative tax on the amount on line 5 from Table A on page 4 of the instructions6

Total gift tax paid or payable with respect to gifts made by the decedent after December 31, 1976.Include gift taxes by the decedent’s spouse for such spouse’s share of split gifts (section 2513) only ifthe decedent was the donor of these gifts and they are includible in the decedent’s gross estate (seeinstructions)

7

7

88 Gross estate tax (subtract line 7 from line 6)99 Maximum unified credit (applicable credit amount) against estate tax

Adjustment to unified credit (applicable credit amount). (This adjustmentmay not exceed $6,000. See page 6 of the instructions.)

1010

1111 Allowable unified credit (applicable credit amount) (subtract line 10 from line 9)Par

t 2—

Tax

Co

mp

utat

ion

1212 Subtract line 11 from line 8 (but do not enter less than zero)

151516

Credit for tax on prior transfers (from Schedule Q)

17

18

Total credits (add lines 13 and 14)

19

Net estate tax (subtract line 15 from line 12)

20

Generation-skipping transfer (GST) taxes payable (from Schedule R, Part 2, line 10)

Total transfer taxes (add lines 16 and 17)

Prior payments. Explain in an attached statementBalance due (or overpayment) (subtract line 19 from line 18)

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of myknowledge and belief, it is true, correct, and complete. Declaration of preparer other than the executor is based on all information of which preparerhas any knowledge.

Cat. No. 20548R

To be filed for decedents dying after December 31, 2008, and before January 1, 2010.

Phone no. ( )

b

c

State death tax deduction

Taxable estate (subtract line 3b from line 3a)

3b

3c

Credit for foreign death taxes (from Schedule(s) P). (Attach Form(s)706-CE.)

13

14

13

14

16

17

18

19

20

Form 706 (Rev. 9-2009)For Privacy Act and Paperwork Reduction Act Notice, see page 30 of the separate instructions for this form.

SignHere

Date

Preparer’ssignature

Check ifself-employed �

Preparer’s SSN or PTIN

Firm’s name (oryours if self-employed),address, and ZIP code

EIN �

Phone no. ( )

�

��

�

Date

PaidPreparer’sUse Only

Date� �Signature of executor

Signature of executor

172 Estate and Gift Programs

I declare that I am the attorney/ certified public accountant/ enrolled agent (you must check the applicable box) for the executor and preparedthis return for the executor. I am not under suspension or disbarment from practice before the Internal Revenue Service and am qualified to practice in thestate shown above.

Form 706 (Rev. 8-2008)

Estate of:Part 3—Elections by the ExecutorPlease check the “Yes” or “No” box for each question (see instructions beginning on page 6). NoYes

Do you elect alternate valuation?1

Do you elect special-use valuation?2If “Yes,” you must complete and attach Schedule A-1.

Do you elect to pay the taxes in installments as described in section 6166?3

If “Yes,” you must attach the additional information described on pages 10 and 11 of the instructions.

Do you elect to postpone the part of the taxes attributable to a reversionary or remainder interest as described insection 6163?

4

Part 4—General Information

Authorization to receive confidential tax information under Regs. sec. 601.504(b)(2)(i); to act as the estate’s representative before the IRS; and to make writtenor oral presentations on behalf of the estate if return prepared by an attorney, accountant, or enrolled agent for the executor:

Address (number, street, and room or suite no., city, state, and ZIP code)StateName of representative (print or type)

Telephone numberCAF number DateSignature

1 Death certificate number and issuing authority (attach a copy of the death certificate to this return).

Dec ent’s business or cupation. If retired, c eck here � and state decedent’s form business or occupation.2

Marital status of the decedent at time of death:3

Married

Wido or widower ame, SSN, a date of death deceased spou �

SingleLegally separated

Divorced—Date divorce decree became final �

4b Social se rity number 4c Amount ceived (see page 12 of the instructions)Surviving spouse’s name4a

Individuals (other than the surviving spouse), trusts, or other estates who receive benefits from the estate (do not include charitable beneficiariesshown in Schedule O) (see instructions).

5

Relationship to decedentIdentifying numberName of individual, trust, or estate receiving $5,000 or more Amount (see instructions)

All unascertainable beneficiaries and those who receive less than $5,000 �

Total

(continued on next page) Page 2

(Note. Please attach the necessary supplemental documents. You must attach the death certificate.)(see instructions on page 12)

Please check the “Yes” or “No” box for each question. NoYes

Does the gross estate contain any section 2044 property (qualified terminable interest property (QTIP) from a prior gift or estate)(see page 12 of the instructions)?

6

1

2

3

Have federal gift tax returns ever been filed?7aIf “Yes,” please attach copies of the returns, if available, and furnish the following information:

7cPeriod(s) covered7b Internal Revenue office(s) where filed

Note. Some of these elections may require the posting of bonds or liens.

Note. By electing section 6166, you may be required to provide security for estate tax deferred undersection 6166 and interest in the form of a surety bond or a section 6324A lien.

8a Was there any insurance on the decedent’s life that is not included on the return as part of the gross estate?

b Did the decedent own any insurance on the life of another that is not included in the gross estate?

Decedent’s Social Security Number

1

2

3

4


Form 706 (Rev. 8-2008)

NoYesIf you answer “Yes” to any of questions 9–16, you must attach additional information as described in the instructions.

Did the decedent at the time of death own any property as a joint tenant with right of survivorship in which (a) one or more ofthe other joint tenants was someone other than the decedent’s spouse, and (b) less than the full value of the property is includedon the return as part of the gross estate? If “Yes,” you must complete and attach Schedule E

9

Did the decedent, at the time of death, own any interest in a partnership (for example, a family limited partnership), an unincorporatedbusiness, or a limited liability company; or own any stock in an inactive or closely held corporation?

10a

11 Did the decedent make any transfer described in section 2035, 2036, 2037, or 2038 (see the instructions for Schedule G beginningon page 15 of the separate instructions)? If “Yes,” you must complete and attach Schedule G

12a Were there in existence at the time of the decedent’s death any trusts created by the decedent during his or her lifetime?

Were there in existence at the time of the decedent’s death any trusts not created by the decedent under which the decedentpossessed any power, beneficial interest, or trusteeship?

b

c Was the decedent receiving income from a trust created after October 22, 1986 by a parent or grandparent?

Did the decedent ever possess, exercise, or release any general power of appointment? If “Yes,” you must complete and attach Schedule H13

14 Did the decedent have an interest in or a signature or other authority over a financial account in a foreign country, such as abank account, securities account, or other financial account?

Was the decedent, immediately before death, receiving an annuity described in the “General” paragraph of the instructions forSchedule I or a private annuity? If “Yes,” you must complete and attach Schedule I

15

Part 5—Recapitulation

Itemnumber Value at date of deathAlternate valueGross estate

Schedule A—Real Estate1

Schedule B—Stocks and Bonds2Schedule C—Mortgages, Notes, and Cash3

Schedule D—Insurance on the Decedent’s Life (attach Form(s) 712)4

Schedule E—Jointly Owned Property (attach Form(s) 712 for life insurance)5

Schedule F—Other Miscellaneous Property (attach Form(s) 712 for life insurance)6

Schedule G—Transfers During Decedent’s Life (att. Form(s) 712 for life insurance)78 Schedule H—Powers of Appointment

Schedule I—Annuities9

Total gross estate (add items 1 through 9)10

Itemnumber AmountDeductions

11

Schedule K—Debts of the Decedent

12

Schedule K—Mortgages and Liens

13

Total of items 13 through 15

14

Allowable amount of deductions from item 16 (see the instructions for item 17 of the Recapitulation)

15

Schedule L—Net Losses During Administration

16

Schedule L—Expenses Incurred in Administering Property Not Subject to Claims

17

Schedule M—Bequests, etc., to Surviving Spouse

18

Schedule O—Charitable, Public, and Similar Gifts and Bequests

1920

Tentative total allowable deductions (add items 17 through 21). Enter here and on line 2 of the Tax Computation

Page 3

Schedule U—Qualified Conservation Easement ExclusionTotal gross estate less exclusion (subtract item 11 from item 10). Enter hereand on line 1 of Part 2—Tax Computation

21

22

Schedule J—Funeral Expenses and Expenses Incurred in Administering Property Subject to Claims

Was the decedent ever the beneficiary of a trust for which a deduction was claimed by the estate of a pre-deceased spouseunder section 2056(b)(7) and which is not reported on this return? If “Yes,” attach an explanation

16

Part 4—General Information (continued)

123456789

1011

12

13141516171819202122

If there was a GST taxable termination (under section 2612), attach a statement to explain. Provide a copy of the trust or willcreating the trust, and give the name, address, and phone number of the current trustee(s).

If “Yes,” was there a GST taxable termination (under section 2612) upon the death of the decedent?

d

Did the decedent at any time during his or her lifetime transfer or sell an interest in a partnership, limited liability company, orclosely held corporation to a trust described in question 12a or 12b?

e

If “Yes,” provide the EIN number to this transferred/sold item. �

If “Yes,” was the value of any interest owned (from above) discounted on this estate tax return? If “Yes,” see the instructions forSchedule F on page 20 for reporting the total accumulated or effective discounts taken on Schedule F or G

b


Form 706 (Rev. 8-2008)

SCHEDULE A—Real Estate● For jointly owned property that must be disclosed on Schedule E, see the instructions on the reverse side of Schedule E.● Real estate that is part of a sole proprietorship should be shown on Schedule F.

● If you elect section 2032A valuation, you must complete Schedule A and Schedule A-1.

Alternatevaluation date

Itemnumber Value at date of deathAlternate valueDescription

1

Total from continuation schedules or additional sheets attached to this schedule

TOTAL. (Also enter on Part 5—Recapitulation, page 3, at item 1.)

(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.)

Schedule A—Page 4(See the instructions on the reverse side.)

● Real estate that is included in the gross estate under section 2035, 2036, 2037, or 2038 should be shown onSchedule G.

● Real estate that is included in the gross estate under section 2041 should be shown on Schedule H.


Estate of:


Form 706 (Rev. 8-2008)


Estate of:

SCHEDULE A-1—Section 2032A Valuation

Part 1. Type of Election (Before making an election, see the checklist on page 7.):Protective election (Regulations section 20.2032A-8(b)). Complete Part 2, line 1, and column A of lines 3 and 4. (see instructions)Regular election. Complete all of Part 2 (including line 11, if applicable) and Part 3. (see instructions)

Part 2. Notice of Election (Regulations section 20.2032A-8(a)(3))Note. All real property entered on lines 2 and 3 must also be entered on Schedules A, E, F, G, or H, as applicable.

Farm used for farming, orQualified use—check one �

�

1Trade or business other than farming

Real property used in a qualified use, passing to qualified heirs, and to be specially valued on this Form 706.2

DCBA

Schedule and item numberfrom Form 706

Value based on qualified use(without section 2032A(b)(3)(B)

adjustment)

Adjusted value (with section2032A(b)(3)(B)

adjustment)

TotalsAttach a legal description of all property listed on line 2.Attach copies of appraisals showing the column B values for all property listed on line 2.

3 Real property used in a qualified use, passing to qualified heirs, but not specially valued on this Form 706.

TotalsIf you checked “Regular election,” you must attach copies of appraisals showing the column B values for all property listed on line 3.

Schedule A-1—Page 8(continued on next page)

Full value (without section 2032A(b)(3)(B)

adjustment)

DCBA

Schedule and item numberfrom Form 706

Value based on qualified use(without section 2032A(b)(3)(B)

adjustment)

Adjusted value (with section2032A(b)(3)(B)

adjustment)

Full value (without section 2032A(b)(3)(B)

adjustment)

Before completing Schedule A-1, see the checklist on page 7 for the information and documents that must be included to makea valid election.The election is not valid unless the agreement (that is, Part 3. Agreement to Special Valuation Under Section 2032A):● Is signed by each and every qualified heir with an interest in the specially valued property and● Is attached to this return when it is filed.


Form 706 (Rev. 8-2008)

Estate of:

SCHEDULE B—Stocks and Bonds(For jointly owned property that must be disclosed on Schedule E, see the instructions for Schedule E.)


Description, including face amount of bonds or number of shares and parvalue for identification. Give CUSIP number. If trust, partnership, or closely

held entity, give EIN

Itemnumber Value at date of deathAlternate valueUnit value

1

Total from continuation schedules (or additional sheets) attached to this schedule


(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.)(The instructions to Schedule B are in the separate instructions.) Schedule B—Page 12

CUSIP number or EIN, where applicable



Form 706 (Rev. 8-2008)

Estate of:

SCHEDULE C—Mortgages, Notes, and Cash(For jointly owned property that must be disclosed on Schedule E, see the instructions for Schedule E.)



1




Schedule C—Page 13(See the instructions on the reverse side.)



Form 706 (Rev. 8-2008)

Estate of:

SCHEDULE D—Insurance on the Decedent’s LifeYou must list all policies on the life of the decedent and attach a Form 712 for each policy.



1


TOTAL. (Also enter on Part 5—Recapitulation, page 3, at item 4.)(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.)

Schedule D—Page 15(See the instructions on the reverse side.)



Form 706 (Rev. 8-2008)

Estate of:SCHEDULE E—Jointly Owned Property

(If you elect section 2032A valuation, you must complete Schedule E and Schedule A-1.)

PART 1. Qualified Joint Interests—Interests Held by the Decedent and His or Her Spouse as the Only JointTenants (Section 2040(b)(2))

Description. For securities, give CUSIP number. If trust, partnership, orclosely held entity, give EIN


Itemnumber Value at date of deathAlternate value


1a Totals

1b Amounts included in gross estate (one-half of line 1a)

PART 2. All Other Joint Interests2a State the name and address of each surviving co-tenant. If there are more than three surviving co-tenants, list the additional co-tenants

on an attached sheet.

Address (number and street, city, state, and ZIP code)Name

A.

B.

C.

Enterletter forco-tenant

Description (including alternate valuation date if any). For securities, giveCUSIP number. If trust, partnership, or closely held entity, give EIN

Includible value atdate of death

Includiblealternate value

Percentageincludible

Itemnumber


2b Total other joint interests

3

(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.)(See the instructions on the reverse side.) Schedule E—Page 17

1a1b

2b

Total includible joint interests (add lines 1b and 2b). Also enter on Part 5—Recapitulation,page 3, at item 5 3

1

1

CUSIP number orEIN, whereapplicable




Form 706 (Rev. 8-2008)

Estate of:

SCHEDULE F—Other Miscellaneous Property Not Reportable Under Any Other Schedule(For jointly owned property that must be disclosed on Schedule E, see the instructions for Schedule E.)

(If you elect section 2032A valuation, you must complete Schedule F and Schedule A-1.)NoYes1 Did the decedent at the time of death own any works of art or items with collectible value in excess of $3,000 or

any collections whose artistic or collectible value combined at date of death exceeded $10,000?If “Yes,” submit full details on this schedule and attach appraisals.

2 Has the decedent’s estate, spouse, or any other person, received (or will receive) any bonus or award as a result ofthe decedent’s employment or death?

Did the decedent at the time of death have, or have access to, a safe deposit box?3If ‘‘Yes,’’ state location, and if held in joint names of decedent and another, state name and relationship of jointdepositor.

If any of the contents of the safe deposit box are omitted from the schedules in this return, explain fully whyomitted.

Description. For securities, give CUSIP number. If trust, partnership, orclosely held entity, give EIN



1



(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.)(See the instructions on the reverse side.)

Schedule F—Page 19

If “Yes,” submit full details on this schedule.




Form 706 (Rev. 8-2008)

Estate of:

SCHEDULE G—Transfers During Decedent’s Life(If you elect section 2032A valuation, you must complete Schedule G and Schedule A-1.)

Description. For securities, give CUSIP number. If trust,partnership, or closely held entity, give EIN



Gift tax paid or payable by the decedent or the estate for all giftsmade by the decedent or his or her spouse within 3 years beforethe decedent’s death (section 2035(b))

A.

Transfers includible under section 2035(a), 2036, 2037, or 2038:B.1



SCHEDULE H—Powers of Appointment

(If you elect section 2032A valuation, you must complete Schedule H and Schedule A-1.)

1


TOTAL. (Also enter on Part 5—Recapitulation, page 3, at item 8.)(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.)(The instructions to Schedules G and H are in the separate instructions.) Schedules G and H—Page 21

Description Alternatevaluation date


(Include “5 and 5 lapsing” powers (section 2041(b)(2)) held by the decedent.)



Form 706 (Rev. 8-2008)

Estate of:

SCHEDULE I—AnnuitiesNote. Generally, no exclusion is allowed for the estates of decedents dying after December 31, 1984 (see page 17 of the instructions).

NoYesAre you excluding from the decedent’s gross estate the value of a lump-sum distribution described in section2039(f)(2) (as in effect before its repeal by the Deficit Reduction Act of 1984)?

A

If “Yes,” you must attach the information required by the instructions.

Includible value at date of death

Includiblealternate value


Description.Show the entire value of the annuity before any exclusions

Itemnumber

1



(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.)(The instructions to Schedule I are in the separate instructions.)Schedule I—Page 22



Form 706 (Rev. 8-2008)

Estate of:

SCHEDULE J—Funeral Expenses and Expenses Incurred in Administering Property Subject to ClaimsNote. Do not list on this schedule expenses of administering property not subject to claims. For those expenses, see the instructionsfor Schedule L.

If executors’ commissions, attorney fees, etc., are claimed and allowed as a deduction for estate tax purposes, they are notallowable as a deduction in computing the taxable income of the estate for federal income tax purposes. They are allowable asan income tax deduction on Form 1041 if a waiver is filed to waive the deduction on Form 706 (see the Form 1041 instructions).

Itemnumber Total amountDescription Expense amount

Funeral expenses:A.1

Total funeral expenses �

Administration expenses:B.Executors’ commissions—amount estimated/agreed upon/paid. (Strike out the words that donot apply.)

1

Attorney fees—amount estimated/agreed upon/paid. (Strike out the words that do not apply.)2

Accountant fees—amount estimated/agreed upon/paid. (Strike out the words that do not apply.)3

Expense amountMiscellaneous expenses:4

Total miscellaneous expenses from continuation schedules (or additional sheets)attached to this scheduleTotal miscellaneous expenses �

TOTAL. (Also enter on Part 5—Recapitulation, page 3, at item 13.) �


Schedule J—Page 23(See the instructions on the reverse side.)



Form 706 (Rev. 8-2008)

Estate of:

SCHEDULE K—Debts of the Decedent, and Mortgages and Liens

Amount claimed asa deduction

Itemnumber

Amount in contestAmount unpaid to dateDebts of the Decedent—Creditor and nature of claim, andallowable death taxes

1



Mortgages and Liens—Description Amount

1



(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.)Schedule K—Page 25(The instructions to Schedule K are in the separate instructions.)

Itemnumber



Form 706 (Rev. 8-2008)

Estate of:

SCHEDULE L—Net Losses During Administration and Expenses Incurred in Administering Property Not Subject to Claims

Net losses during administrationItemnumber Amount(Note. Do not deduct losses claimed on a federal income tax return.)

1



Expenses incurred in administering property not subject toclaims. (Indicate whether estimated, agreed upon, or paid.)

Itemnumber Amount

1



(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.)Schedule L—Page 26 (The instructions to Schedule L are in the separate instructions.)



Form 706 (Rev. 8-2008)

Estate of:SCHEDULE M—Bequests, etc., to Surviving Spouse

Yes No

Did any property pass to the surviving spouse as a result of a qualified disclaimer?1If ‘‘Yes,’’ attach a copy of the written disclaimer required by section 2518(b).

Is the surviving spouse a U.S. citizen?

Election Out of QTIP Treatment of Annuities. Do you elect under section 2056(b)(7)(C)(ii) not to treat as qualifiedterminable interest property any joint and survivor annuities that are included in the gross estate and would otherwisebe treated as qualified terminable interest property under section 2056(b)(7)(C)? (see instructions)

Itemnumber

Description of property interests passing to surviving spouse.For securities, give CUSIP number. If trust, partnership, or closely held entity, give EIN

Amount

A1


Total amount of property interests listed on Schedule M

(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.)(See the instructions on the reverse side.)

Schedule M—Page 27

Election To Deduct Qualified Terminable Interest Property Under Section 2056(b)(7). If a trust (or other property) meets therequirements of qualified terminable interest property under section 2056(b)(7), and

a. The trust or other property is listed on Schedule M and

then unless the executor specifically identifies the trust (all or a fractional portion or percentage) or other property to beexcluded from the election, the executor shall be deemed to have made an election to have such trust (or other property)treated as qualified terminable interest property under section 2056(b)(7).

In what country was the surviving spouse born?

b. The value of the trust (or other property) is entered in whole or in part as a deduction on Schedule M,

What is the surviving spouse’s date of birth?

If the surviving spouse is a naturalized citizen, when did the surviving spouse acquire citizenship?If the surviving spouse is not a U.S. citizen, of what country is the surviving spouse a citizen?

2a

3

bcde

If less than the entire value of the trust (or other property) that the executor has included in the gross estate is entered as adeduction on Schedule M, the executor shall be considered to have made an election only as to a fraction of the trust (or otherproperty). The numerator of this fraction is equal to the amount of the trust (or other property) deducted on Schedule M. Thedenominator is equal to the total value of the trust (or other property).

45a

6

bc

d

Federal estate taxes payable out of property interests listed on Schedule MOther death taxes payable out of property interests listed on Schedule M

Add items 5a, 5b, and 5cNet amount of property interests listed on Schedule M (subtract 5d from 4). Also enter on Part 5—Recapitulation, page 3, at item 20

Federal and state GST taxes payable out of property interests listedon Schedule M

4

6

5d5c

5b5a

Election To Deduct Qualified Domestic Trust Property Under Section 2056A. If a trust meets the requirements of a qualifieddomestic trust under section 2056A(a) and this return is filed no later than 1 year after the time prescribed by law (includingextensions) for filing the return, and

a. The entire value of a trust or trust property is listed on Schedule M andb. The entire value of the trust or trust property is entered as a deduction on Schedule M, then unless the executor specifically

identifies the trust to be excluded from the election, the executor shall be deemed to have made an election to have the entiretrust treated as qualified domestic trust property.

1

2c

3

QTIP property:

B1

All other property:



Form 706 (Rev. 8-2008)

Estate of:

SCHEDULE O—Charitable, Public, and Similar Gifts and BequestsNoYes

If the transfer was made by will, has any action been instituted to have interpreted or to contest the will or anyof its provisions affecting the charitable deductions claimed in this schedule?

1a

If ‘‘Yes,’’ full details must be submitted with this schedule.

b According to the information and belief of the person or persons filing this return, is any such action planned?If ‘‘Yes,’’ full details must be submitted with this schedule.

2 Did any property pass to charity as the result of a qualified disclaimer?If ‘‘Yes,’’ attach a copy of the written disclaimer required by section 2518(b).

Itemnumber Name and address of beneficiary Character of institution Amount

1


3Total3

Federal estate tax payable out of property interests listed above4a 4a

4bOther death taxes payable out of property interests listed aboveb

4cFederal and state GST taxes payable out of property interests listed abovec

4dd Add items 4a, 4b, and 4c

5Net value of property interests listed above (subtract 4d from 3). Also enter on Part 5—Recapitulation,page 3, at item 21

5

(If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.)(The instructions to Schedule O are in the separate instructions.)

Schedule O—Page 31



United States Estate (and Generation-Skipping Transfer) Tax Return

706-NA

Form

OMB No. 1545-0531

(Rev. September 2009)

Estate of nonresident not a citizen of the United States Department of the Treasury


� See separate instructions. Attach supplemental documents and translations. Show amounts in U.S. dollars.

Decedent, Executor, and Attorney 1a

b

2

4

3

b

8

7a

10a

9a

InUnitedStates

b

b

12a

11a

OutsideUnitedStates

b

b

Tax Computation 1 1 Taxable estate from Schedule B, line 9

2 Total taxable gifts of tangible or intangible property located in the U.S., transferred (directly or indirectly)by the decedent after December 31, 1976, and not included in the gross estate (see section 2511)

2 3 3 Total. Add lines 1 and 2

4 Tentative tax on the amount on line 3 (see instructions)

4 5 5 Tentative tax on the amount on line 2 (see instructions)

6 Gross estate tax. Subtract line 5 from line 4

6 7 Unified credit. Enter smaller of line 6 amount or maximum allowed (see instructions)

7

8 Balance. Subtract line 7 from line 6

8 9

Credit for tax on prior transfers. Attach Schedule Q, Form 706

10 Other credits (see instructions)

10 11 Total. Add lines 9 and 10

11

12 Net estate tax. Subtract line 11 from line 8

12 13 Total generation-skipping transfer tax. Attach Schedule R, Form 706

13

14 Total transfer taxes. Add lines 12 and 13

14 15 Earlier payments. See instructions and attach explanation

15

Balance due. Subtract line 15 from line 14 (see instructions)

16 16 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. I understand that a complete return requires listing all property constituting the part of the decedent’s gross estate (as defined bythe statute) situated in the United States. Declaration of preparer (other than executor) is based on all information of which preparer has any knowledge.

Form 706-NA (Rev. 9-2009)

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Part I

Part II

Cat. No. 10145K

To be filed for decedents dying after December 31, 2008.

9

5

6

Business or occupation

Name of attorney for estate

Name of attorney for estate

Address

Address

Decedent’s first (given) name and middle initial

Place of death

Date of birth

Place of birth

Domicile at time of death

Decedent’s last (family) name

Name of executor

Address

Name of executor

Address

U.S. taxpayer ID number (if any)

Date of death

Citizenship (nationality)


Date Preparer’s

signature


Firm’s name (oryours, if self-employed),address, and ZIP code

Phone no. ( )

� � EIN

Checkif self-employed

Date

SignHere � � Signature of executor

Date

� � Signature of executor

-


Page 2

Form 706-NA (Rev. 9-2009)

General Information No

Yes

No

Yes

Did the decedent make any transfer (ofproperty that was located in the United Statesat either the time of the transfer or the timeof death) described in sections 2035, 2036,2037, or 2038 (see the instructions for Form706, Schedule G)?

7

Did the decedent die testate?

1a Were letters testamentary or of administration

granted for the estate?

b

If granted to persons other than those filing thereturn, include names and addresses on page 1.

If “Yes,” attach Schedule G, Form 706. Did the decedent, at the time of death, own any:

2

At the date of death, were there any trusts inexistence that were created by the decedentand that included property located in theUnited States either when the trust wascreated or when the decedent died?

8 Real property located in the United States?

a U.S. corporate stock?

b Debt obligations of (1) a U.S. person, or (2) the

United States, a state or any politicalsubdivision, or the District of Columbia?

c

If “Yes,” attach Schedule G, Form 706. Other property located in the United States?

d

At the date of death, did the decedent:

9 Was the decedent engaged in business in the

United States at the date of death?

3

Have a general power of appointment overany property located in the United States?

a b

Or, at any time, exercise or release the power?

At the date of death, did the decedent haveaccess, personally or through an agent, to asafe deposit box located in the United States?

4 If “Yes” to either a or b, attach Schedule H, Form 706.

Have federal gift tax returns ever been filed?

10a At the date of death, did the decedent own

any property located in the United States asa joint tenant with right of survivorship; as atenant by the entirety; or, with survivingspouse, as community property?

5 Periods covered �

b IRS offices where filed �

c

11

Does the gross estate in the United Statesinclude any interests in property transferredto a “skip person” as defined in theinstructions to Schedule R of Form 706?

If “Yes,” attach Schedule E, Form 706. Had the decedent ever been a citizen or resident of the United States (see instructions)?

6a

If “Yes,” did the decedent lose U.S. citizenship orresidency within 10 years of death? (see instructions)

If “Yes,” attach Schedules R and/or R-1, Form706.

b

No Yes Schedule A. Gross Estate in the United States (see instructions) Do you elect to value the decedent’s gross estate at a date or dates after the decedent’s death (as authorized by section 2032)? �

To make the election, you must check this box ‘‘Yes.’’ If you check ‘‘Yes,’’ complete all columns. If you check ‘‘No,’’ completecolumns (a), (b), and (e); you may leave columns (c) and (d) blank or you may use them to expand your column (b) description. (a)Itemno.

(e)Value at date of

death in U.S. dollars

(d)Alternate value in

U.S. dollars

(c)Alternate

valuation date

(b)Description of property and securities

For securities, give CUSIP number

1

(If you need more space, attach additional sheets of same size.) Total

Schedule B. Taxable Estate Caution. You must document lines 2 and 4 for the deduction on line 5 to be allowed.

1

Gross estate in the United States (Schedule A total)

1 2

Gross estate outside the United States (see instructions)

2 3

Entire gross estate wherever located. Add amounts on lines 1 and 2

3 Amount of funeral expenses, administration expenses, decedent’s debts, mortgages and liens, and

losses during administration. Attach itemized schedule. (see instructions)

4 4

5

Deduction for expenses, claims, etc. Divide line 1 by line 3 and multiply the result by line 4

5 Charitable deduction (attach Schedule O, Form 706) and marital deduction (attach Schedule M, Form

706, and computation)

6 6

8

Total deductions. Add lines 5, 6, and 7

8 9

Taxable estate. Subtract line 8 from line 1. Enter here and on line 1 of Part II

9

Part III

Form 706-NA (Rev. 9-2009)

7

State death tax deduction (see instructions)

7



United States Gift (and Generation-Skipping Transfer) Tax Return (For gifts made during calendar year 2010)


OMB No. 1545-0020

2010

Par

t 1—

Gen

eral

Info

rmat

ion

1 Donor’s first name and middle initial 2 Donor’s last name 3 Donor’s social security number

5 Legal residence (domicile)

6 City, state, and ZIP code 7 Citizenship (see instructions)

8 If the donor died during the year, check here ▶ and enter date of death , . Yes No

9 If you extended the time to file this Form 709, check here ▶

10 Enter the total number of donees listed on Schedule A. Count each person only once. ▶

11 a Have you (the donor) previously filed a Form 709 (or 709-A) for any other year? If "No," skip line 11b . . . . . . .b If the answer to line 11a is "Yes," has your address changed since you last filed Form 709 (or 709-A)? . . . . . . .

12 Gifts by husband or wife to third parties. Do you consent to have the gifts (including generation-skipping transfers) made by you and by your spouse to third parties during the calendar year considered as made one-half by each of you? (See instructions.) (If the answer is “Yes,” the following information must be furnished and your spouse must sign the consent shown below. If the answer is “No,” skip lines 13–18 and go to Schedule A.) . . . . . . . . . . . . .

13 Name of consenting spouse 14 SSN

15 Were you married to one another during the entire calendar year? (see instructions) . . . . . . . . . . . .

16 If 15 is “No,” check whether married divorced or widowed/deceased, and give date (see instructions) ▶

17 Will a gift tax return for this year be filed by your spouse? (If “Yes,” mail both returns in the same envelope.) . . . . .18 Consent of Spouse. I consent to have the gifts (and generation-skipping transfers) made by me and by my spouse to third parties during the calendar year

considered as made one-half by each of us. We are both aware of the joint and several liability for tax created by the execution of this consent.

Consenting spouse’s signature ▶ Date ▶

Par

t 2—

Tax

Co

mp

utat

ion

1 Enter the amount from Schedule A, Part 4, line 11 . . . . . . . . . . . . . . . 1

2 Enter the amount from Schedule B, line 3 . . . . . . . . . . . . . . . . . 2

3 Total taxable gifts. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . 3

4 Tax computed on amount on line 3 (see Table for Computing Gift Tax in separate instructions) . . 4

5 Tax computed on amount on line 2 (see Table for Computing Gift Tax in separate instructions) . . 5

6 Balance. Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . 6

7 Maximum unified credit (nonresident aliens, see instructions) . . . . . . . . . . . . 7

8 Enter the unified credit against tax allowable for all prior periods (from Sch. B, line 1, col. C) . . 8

9 Balance. Subtract line 8 from line 7. Do not enter less than zero . . . . . . . . . . . 9 10 Enter 20% (.20) of the amount allowed as a specific exemption for gifts made after September 8,

1976, and before January 1, 1977 (see instructions) . . . . . . . . . . . . . . 10

11 Balance. Subtract line 10 from line 9. Do not enter less than zero . . . . . . . . . . 11

12 Unified credit. Enter the smaller of line 6 or line 11 . . . . . . . . . . . . . . . 12

13 Credit for foreign gift taxes (see instructions) . . . . . . . . . . . . . . . . 13

14 Total credits. Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . 14

15 Balance. Subtract line 14 from line 6. Do not enter less than zero . . . . . . . . . . 15

Att

ach

chec

k o

r m

one

y o

rder

her

e.

16 Generation-skipping transfer taxes (from Schedule C, Part 3, col. H, Total) . . . . . . . . 16

17 Total tax. Add lines 15 and 16 . . . . . . . . . . . . . . . . . . . . . 17

18 Gift and generation-skipping transfer taxes prepaid with extension of time to file . . . . . . 18

19 If line 18 is less than line 17, enter balance due (see instructions) . . . . . . . . . . 19

20 If line 18 is greater than line 17, enter amount to be refunded . . . . . . . . . . . 20

Sign Here

Under penalties of perjury, I declare that I have examined this return, including any accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than donor) is based on all information of which preparer has any knowledge.

May the IRS discuss this return with the preparer shown below (see instructions)? Yes No ▲

Signature of donor Date



PTIN

Firm’s name ▶

Firm’s address ▶Firm's EIN ▶

Phone no.

For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see the separate instructions for this form. Cat. No. 16783M Form 709 (2010)

4 Address (number, street, and apartment number)


Form 709 (2010) Page 2 SCHEDULE A Computation of Taxable Gifts (Including transfers in trust) (see instructions)

A Does the value of any item listed on Schedule A reflect any valuation discount? If “Yes,” attach explanation . . . . . . Yes No

B ◀ Check here if you elect under section 529(c)(2)(B) to treat any transfers made this year to a qualified tuition program as made ratably over a 5-year period beginning this year. See instructions. Attach explanation.

Part 1—Gifts Subject Only to Gift Tax. Gifts less political organization, medical, and educational exclusions. (see instructions)

A Item

number

B • Donee’s name and address • Relationship to donor (if any) • Description of gift • If the gift was of securities, give CUSIP no. • If closely held entity, give EIN

C D Donor’s adjusted

basis of gift

E Date of gift

F Value at

date of gift

G For split

gifts, enter 1/2 of

column F

H Net transfer

(subtract col. G from

col. F)

Gifts made by spouse —complete only if you are splitting gifts with your spouse and he/she also made gifts.

Total of Part 1. Add amounts from Part 1, column H . . . . . . . . . . . . . . . . . . . . . . ▶

Part 2—Direct Skips. Gifts that are direct skips and are subject to both gift tax and generation-skipping transfer tax. You must list the gifts in chronological order.

A Item

number


C 2632(b) election

out

D Donor’s adjusted

basis of gift

E Date of gift

F Value at

date of gift

G For split

gifts, enter 1/2 of

column F

H Net transfer


col. F)



Part 3—Indirect Skips. Gifts to trusts that are currently subject to gift tax and may later be subject to generation-skipping transfer tax. You must list these gifts in chronological order.

A Item

number


C 2632(c) election

D Donor’s adjusted

basis of gift

E Date of gift

F Value at

date of gift

G For split

gifts, enter 1/2 of

column F

H Net transfer


col. F)



(If more space is needed, attach additional sheets of same size.) Form 709 (2010)


Form 709 (2010) Page 3 Part 4—Taxable Gift Reconciliation

1 Total value of gifts of donor. Add totals from column H of Parts 1, 2, and 3 . . . . . . . . . . 1

2 Total annual exclusions for gifts listed on line 1 (see instructions) . . . . . . . . . . . . . 2

3 Total included amount of gifts. Subtract line 2 from line 1 . . . . . . . . . . . . . . . 3

Deductions (see instructions)

4 Gifts of interests to spouse for which a marital deduction will be claimed, based

on item numbers of Schedule A . .

5 Exclusions attributable to gifts on line 4 . . . . . . . . . . . . 5

6 Marital deduction. Subtract line 5 from line 4 . . . . . . . . . . . 6

7 Charitable deduction, based on item nos. less exclusions . 7

8 Total deductions. Add lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . 8


10 Generation-skipping transfer taxes payable with this Form 709 (from Schedule C, Part 3, col. H, Total) . . 10 0 00 11 Taxable gifts. Add lines 9 and 10. Enter here and on page 1, Part 2—Tax Computation, line 1 . . . . 11

Terminable Interest (QTIP) Marital Deduction. (See instructions for Schedule A, Part 4, line 4.) If a trust (or other property) meets the requirements of qualified terminable interest property under section 2523(f), and:

a. The trust (or other property) is listed on Schedule A, and

b. The value of the trust (or other property) is entered in whole or in part as a deduction on Schedule A, Part 4, line 4, then the donor shall be deemed to have made an election to have such trust (or other property) treated as qualified terminable interest property under section 2523(f).

If less than the entire value of the trust (or other property) that the donor has included in Parts 1 and 3 of Schedule A is entered as a deduction on line 4, the donor shall be considered to have made an election only as to a fraction of the trust (or other property). The numerator of this fraction is equal to the amount of the trust (or other property) deducted on Schedule A, Part 4, line 6. The denominator is equal to the total value of the trust (or other property) listed in Parts 1 and 3 of Schedule A.

If you make the QTIP election, the terminable interest property involved will be included in your spouse’s gross estate upon his or her death (section 2044). See instructions for line 4 of Schedule A. If your spouse disposes (by gift or otherwise) of all or part of the qualifying life income interest, he or she will be considered to have made a transfer of the entire property that is subject to the gift tax. See Transfer of Certain Life Estates Received From Spouse in the separate instructions.

12 Election Out of QTIP Treatment of Annuities ◀ Check here if you elect under section 2523(f)(6) not to treat as qualified terminable interest property any joint and survivor annuities that are

reported on Schedule A and would otherwise be treated as qualified terminable interest property under section 2523(f). See instructions. Enter the item numbers from Schedule A for the annuities for which you are making this election ▶

SCHEDULE B Gifts From Prior Periods If you answered “Yes” on line 11a of page 1, Part 1, see the instructions for completing Schedule B. If you answered “No,” skip to the Tax Computation on page 1 (or Schedule C, if applicable). See instructions for recalculation of the column C amounts. Attach calculations.

A Calendar year or calendar quarter (see instructions)

B Internal Revenue office

where prior return was filed

C Amount of unified

credit against gift tax for periods after

December 31, 1976

D Amount of specific exemption for prior

periods ending before January 1, 1977

E Amount of

taxable gifts

1 Totals for prior periods . . . . . . . . . . . . 1

2 Amount, if any, by which total specific exemption, line 1, column D is more than $30,000 . . . . . . 2 3 Total amount of taxable gifts for prior periods. Add amount on line 1, column E and amount, if any, on line 2.

Enter here and on page 1, Part 2—Tax Computation, line 2 . . . . . . . . . . . . . . 3 (If more space is needed, attach additional sheets of same size.) Form 709 (2010)

4


Not applicable to transfers

made in 2010

Not applicable to transfers

made in 2010

Form 709 (2010) Page 4 SCHEDULE C Computation of Generation-Skipping Transfer Tax

Note. Inter vivos direct skips that are completely excluded by the GST exemption must still be fully reported (including value and exemptions claimed) on Schedule C.

Part 1—Generation-Skipping Transfers A

Item No. (from Schedule A,

Part 2, col. A)

B Value (from Schedule A,

Part 2, col. H)

C Nontaxable

portion of transfer

D Net Transfer (subtract

col. C from col. B)

Gifts made by spouse (for gift splitting only)

Part 2—GST Exemption Reconciliation (Section 2631) and Section 2652(a)(3) Election Check here ▶ if you are making a section 2652(a)(3) (special QTIP) election (see instructions)

Enter the item numbers from Schedule A of the gifts for which you are making this election ▶

1 Maximum allowable exemption (see instructions) . . . . . . . . . . . . . . . . . . . 1

2 Total exemption used for periods before filing this return . . . . . . . . . . . . . . . . . 2

3 Exemption available for this return. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . 3

4 Exemption claimed on this return from Part 3, column C total, below . . . . . . . . . . . . . . 4

5 Automatic allocation of exemption to transfers reported on Schedule A, Part 3 (see instructions) . . . . . . 5 6 Exemption allocated to transfers not shown on line 4 or 5, above. You must attach a “Notice of Allocation.”

(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Add lines 4, 5, and 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 Exemption available for future transfers. Subtract line 7 from line 3 . . . . . . . . . . . . . . 8 Part 3—Tax Computation

A Item No.

(from Schedule C, Part 1)

B Net transfer

(from Schedule C, Part 1, col. D)

C GST Exemption

Allocated

D RESERVED

E RESERVED

F RESERVED

G Applicable Rate

H Generation-Skipping

Transfer Tax (multiply col. B by col. G)

Gifts made by spouse (for gift splitting only)

Total exemption claimed. Enter here and on Part 2, line 4, above. May not exceed Part 2, line 3, above . . . . . . .

Total generation-skipping transfer tax. Enter here; on page 3, Schedule A, Part 4, line 10; and on page 1, Part 2—Tax Computation, line 16 . . . . . . . . . . . . . .

(If more space is needed, attach additional sheets of same size.) Form 709 (2010)

194 Tax-Exempt Organizations Programs

Form 990


Return of Organization Exempt From Income TaxUnder section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung

benefit trust or private foundation)

The organization may have to use a copy of this return to satisfy state reporting requirements.

OMB No. 1545-0047

2010Open to Public

InspectionA For the 2010 calendar year, or tax year beginning , 2010, and ending , 20

B Check if applicable:

Address change

Name change

Initial return

Terminated

Amended return

Application pending

C Name of organization

Doing Business As

Number and street (or P.O. box if mail is not delivered to street address) Room/suite

City or town, state or country, and ZIP + 4

D Employer identification number

E Telephone number

F Name and address of principal officer:

G Gross receipts $

H(a) Is this a group return for affiliates? Yes No

H(b) Are all affiliates included? Yes No If “No,” attach a list. (see instructions)

H(c) Group exemption number

I Tax-exempt status: 501(c)(3) 501(c) ( ) (insert no.) 4947(a)(1) or 527

J Website: K Form of organization: Corporation Trust Association Other L Year of formation: M State of legal domicile:

Part I Summary

Act

ivit

ies

& G

ove

rnan

ce

1 Briefly describe the organization’s mission or most significant activities:

2 Check this box if the organization discontinued its operations or disposed of more than 25% of its net assets.3 Number of voting members of the governing body (Part VI, line 1a) . . . . . . . . . 3 4 Number of independent voting members of the governing body (Part VI, line 1b) . . . . 4 5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) . . . . . 5 6 Total number of volunteers (estimate if necessary) . . . . . . . . . . . . . . 6 7 a Total unrelated business revenue from Part VIII, column (C), line 12 . . . . . . . . 7a b Net unrelated business taxable income from Form 990-T, line 34 . . . . . . . . . 7b

Rev

enue

Prior Year Current Year

8 Contributions and grants (Part VIII, line 1h) . . . . . . . . . . . .9 Program service revenue (Part VIII, line 2g) . . . . . . . . . . .

10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) . . . . . .11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) . . .12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)

Exp

ense

s

13 Grants and similar amounts paid (Part IX, column (A), lines 1–3) . . . . .14 Benefits paid to or for members (Part IX, column (A), line 4) . . . . . .15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)16a Professional fundraising fees (Part IX, column (A), line 11e) . . . . . .

b Total fundraising expenses (Part IX, column (D), line 25) 17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f) . . . . . .18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) .19 Revenue less expenses. Subtract line 18 from line 12 . . . . . . . .

Net

Ass

ets

or

Fund

Bal

ance

s Beginning of Current Year End of Year

20 Total assets (Part X, line 16) . . . . . . . . . . . . . . . .21 Total liabilities (Part X, line 26) . . . . . . . . . . . . . . . .22 Net assets or fund balances. Subtract line 21 from line 20 . . . . . .

Part II Signature BlockUnder penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign Here

Signature of officer Date

Type or print name and title



PTIN

Firm’s name Firm's EIN

Firm's address Phone no.

May the IRS discuss this return with the preparer shown above? (see instructions) . . . . . . . . . . . . Yes No

For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 11282Y Form 990 (2010)

195Tax-Exempt Organizations Programs

Form 990 (2010) Page 2Part III Statement of Program Service Accomplishments

Check if Schedule O contains a response to any question in this Part III . . . . . . . . . . . . . .1 Briefly describe the organization’s mission:

2 Did the organization undertake any significant program services during the year which were not listed on theprior Form 990 or 990-EZ? . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes NoIf “Yes,” describe these new services on Schedule O.

3 Did the organization cease conducting, or make significant changes in how it conducts, any programservices? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes NoIf “Yes,” describe these changes on Schedule O.

4 Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses. Section501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4 a (Code: ) (Expenses $ including grants of $ ) (Revenue $ )

4b (Code: ) (Expenses $ including grants of $ ) (Revenue $ )

4 c (Code: ) (Expenses $ including grants of $ ) (Revenue $ )

4d Other program services. (Describe in Schedule O.)(Expenses $ including grants of $ ) (Revenue $ )

4e Total program service expenses Form 990 (2010)


Form 990 (2010) Page 3Part IV Checklist of Required Schedules

Yes No

1 Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Is the organization required to complete Schedule B, Schedule of Contributors? (see instructions) . . . 23 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to

candidates for public office? If “Yes,” complete Schedule C, Part I . . . . . . . . . . . . . . 3 4 Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h)

election in effect during the tax year? If “Yes,” complete Schedule C, Part II . . . . . . . . . . . 4 5 Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues,

assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part II . . . 7

8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III . . . . . . . . . . . . . . . . . . . . . . . . . . 8

9 Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Did the organization, directly or through a related organization, hold assets in term, permanent, or quasi-endowments? If “Yes,” complete Schedule D, Part V . . . . . . . . . . . . . . . . . . 10

11 If the organization’s answer to any of the following questions is “Yes,” then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.

a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If “Yes,”complete Schedule D, Part VI . . . . . . . . . . . . . . . . . . . . . . . . . . 11a

b Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII . . . . . . . . 11b

c Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII . . . . . . . . 11c

d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX . . . . . . . . . . . . . . 11d

e Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X 11e f Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses

the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X . 11f 12 a Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete

Schedule D, Parts XI, XII, and XIII . . . . . . . . . . . . . . . . . . . . . . . . . 12a b Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if

the organization answered "No" to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional . . . . . 12b13 Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E . . . . 13 14 a Did the organization maintain an office, employees, or agents outside of the United States? . . . . . 14a

b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Parts I and IV 14b

15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to anyorganization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV . . 15

16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV . . . . 16

17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services onPart IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions) . . . . . 17

18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II . . . . . . . . . . . . . . . 18

19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III . . . . . . . . . . . . . . . . . . . . . . . 19

20 a Did the organization operate one or more hospitals? If “Yes,” complete Schedule H . . . . . . . . 20a b If “Yes” to line 20a, did the organization attach its audited financial statements to this return? Note. Some

Form 990 filers that operate one or more hospitals must attach audited financial statements (see instructions) 20bForm 990 (2010)


Form 990 (2010) Page 4Part IV Checklist of Required Schedules (continued)

Yes No

21 Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II . . . . . 21

22 Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III . . . . . . . . . . . . 22

23 Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of theorganization’s current and former officers, directors, trustees, key employees, and highest compensatedemployees? If “Yes,” complete Schedule J . . . . . . . . . . . . . . . . . . . . . . 23

24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24bthrough 24d and complete Schedule K. If “No,” go to line 25 . . . . . . . . . . . . . . . . 24a

b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? . . 24bc Did the organization maintain an escrow account other than a refunding escrow at any time during the year

to defease any tax-exempt bonds? . . . . . . . . . . . . . . . . . . . . . . . . 24cd Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year? . . 24d

25a Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I . . . . . . . . . 25a

b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I . . . . . . . . . . . . . . . . . . . . . . . . 25b

26 Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L, Part II . . 26

27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III . . . . . . . . . . . . . . . . . . . . . . . 27

28 Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):

a A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV . . 28ab A family member of a current or former officer, director, trustee, or key employee? If “Yes,” complete

Schedule L, Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28bc An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof)

was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV . . . 28c29 Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M 2930 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified

conservation contributions? If “Yes,” complete Schedule M . . . . . . . . . . . . . . . . 3031 Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,

Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3132 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,”

complete Schedule N, Part II . . . . . . . . . . . . . . . . . . . . . . . . . . 3233 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations

sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I . . . . . . . . . . . 3334 Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III,

IV, and V, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3435 Is any related organization a controlled entity within the meaning of section 512(b)(13)? . . . . . . . 35

a Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitablerelated organization? If “Yes,” complete Schedule R, Part V, line 2 . . . . . . . . . . . . . . 36

37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

38 Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O . . . . . . . . . . . . . . 38

Form 990 (2010)


Form 990 (2010) Page 5Part V Statements Regarding Other IRS Filings and Tax Compliance

Check if Schedule O contains a response to any question in this Part V . . . . . . . . . . . . . .Yes No

1a Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable . . . . 1ab Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable . . . . 1bc Did the organization comply with backup withholding rules for reportable payments to vendors and

reportable gaming (gambling) winnings to prize winners? . . . . . . . . . . . . . . . . . 1c2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax

Statements, filed for the calendar year ending with or within the year covered by this return 2ab If at least one is reported on line 2a, did the organization file all required federal employment tax returns? . 2b

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)3a Did the organization have unrelated business gross income of $1,000 or more during the year? . . . . 3ab If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O . . . . . 3b

4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financialaccount)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4a

b If “Yes,” enter the name of the foreign country: See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.

5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? . . . 5ab Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? 5bc If “Yes” to line 5a or 5b, did the organization file Form 8886-T? . . . . . . . . . . . . . . . 5c

6a Does the organization have annual gross receipts that are normally greater than $100,000, and did theorganization solicit any contributions that were not tax deductible? . . . . . . . . . . . . . . 6a

b If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? . . . . . . . . . . . . . . . . . . . . . . . . . . 6b

7 Organizations that may receive deductible contributions under section 170(c).a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods

and services provided to the payor? . . . . . . . . . . . . . . . . . . . . . . . . 7ab If “Yes,” did the organization notify the donor of the value of the goods or services provided? . . . . . 7bc Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was

required to file Form 8282? . . . . . . . . . . . . . . . . . . . . . . . . . . . 7cd If “Yes,” indicate the number of Forms 8282 filed during the year . . . . . . . . 7de Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? 7ef Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . 7fg If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? 7gh If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? 7h

8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year? . . . . . . . . . . . 8

9 Sponsoring organizations maintaining donor advised funds.a Did the organization make any taxable distributions under section 4966? . . . . . . . . . . . . 9ab Did the organization make a distribution to a donor, donor advisor, or related person? . . . . . . . 9b

10 Section 501(c)(7) organizations. Enter:a Initiation fees and capital contributions included on Part VIII, line 12 . . . . . . . 10ab Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities . 10b

11 Section 501(c)(12) organizations. Enter:a Gross income from members or shareholders . . . . . . . . . . . . . . . 11ab Gross income from other sources (Do not net amounts due or paid to other sources

against amounts due or received from them.) . . . . . . . . . . . . . . . 11b12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041? 12a

b If “Yes,” enter the amount of tax-exempt interest received or accrued during the year . . 12b13 Section 501(c)(29) qualified nonprofit health insurance issuers.

a Is the organization licensed to issue qualified health plans in more than one state? . . . . . . . . 13aNote. See the instructions for additional information the organization must report on Schedule O.

b Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans . . . . . . . . . . 13b

c Enter the amount of reserves on hand . . . . . . . . . . . . . . . . . 13c14a Did the organization receive any payments for indoor tanning services during the tax year? . . . . . . 14a

b If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O . 14bForm 990 (2010)


Form 990 (2010) Page 6Part VI Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a

“No” response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . . . . . .

Section A. Governing Body and ManagementYes No

1a Enter the number of voting members of the governing body at the end of the tax year . . 1ab Enter the number of voting members included in line 1a, above, who are independent . 1b

2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? . . . . . . . . . . . . . . . . . . 2

3 Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? . . 3

4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? 45 Did the organization become aware during the year of a significant diversion of the organization’s assets? . 56 Does the organization have members or stockholders? . . . . . . . . . . . . . . . . . . 67a Does the organization have members, stockholders, or other persons who may elect one or more members

of the governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7ab Are any decisions of the governing body subject to approval by members, stockholders, or other persons? 7b

8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

a The governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8ab Each committee with authority to act on behalf of the governing body? . . . . . . . . . . . . 8b

9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O . . . . . 9

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)Yes No

10a Does the organization have local chapters, branches, or affiliates? . . . . . . . . . . . . . . 10ab If “Yes,” does the organization have written policies and procedures governing the activities of such

chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? . 10b11a Has the organization provided a copy of this Form 990 to all members of its governing body before filing the

form? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11ab Describe in Schedule O the process, if any, used by the organization to review this Form 990.

12a Does the organization have a written conflict of interest policy? If “No,” go to line 13 . . . . . . . . 12ab Are officers, directors or trustees, and key employees required to disclose annually interests that could give

rise to conflicts? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12bc Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,”

describe in Schedule O how this is done . . . . . . . . . . . . . . . . . . . . . . . 12c13 Does the organization have a written whistleblower policy? . . . . . . . . . . . . . . . . 1314 Does the organization have a written document retention and destruction policy? . . . . . . . . . 1415 Did the process for determining compensation of the following persons include a review and approval by

independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

a The organization’s CEO, Executive Director, or top management official . . . . . . . . . . . . 15ab Other officers or key employees of the organization . . . . . . . . . . . . . . . . . . . 15b

If “Yes” to line 15a or 15b, describe the process in Schedule O. (See instructions.) . . . . . . . . .16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement

with a taxable entity during the year? . . . . . . . . . . . . . . . . . . . . . . . . 16ab If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its

participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard theorganization’s exempt status with respect to such arrangements? . . . . . . . . . . . . . . 16b

Section C. Disclosure17 List the states with which a copy of this Form 990 is required to be filed 18 Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available

for public inspection. Indicate how you make these available. Check all that apply.

Own website Another’s website Upon request19 Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy,

and financial statements available to the public.20 State the name, physical address, and telephone number of the person who possesses the books and records of the

organization:

Form 990 (2010)


Form 990 (2010) Page 7 Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees,

and Independent ContractorsCheck if Schedule O contains a response to any question in this Part VII . . . . . . . . . . . . . .

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.

• List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

• List all of the organization’s current key employees, if any. See instructions for definition of “key employee.” • List the organization’s five current highest compensated employees (other than an officer, director, trustee, or key employee)

who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from theorganization and any related organizations.

• List all of the organization’s former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations.

• List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations.List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees; and former such persons.

Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.(A)

Name and Title

(B)

Average hours per

week (describe hours for related

organizations in Schedule

O)

(C)

Position (check all that apply)

Individ

ual trustee or d

irector

Institutional trustee

Officer

Key em

ployee

Highest com

pensated em

ployee

Former

(D)

Reportable compensation

from the

organization (W-2/1099-MISC)

(E)

Reportable compensation from

related organizations

(W-2/1099-MISC)

(F)

Estimated amount of

other compensation

from the organization and related

organizations

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

Form 990 (2010)

✔✔ ✔


Form 990 (2010) Page 8 Part VII Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)

(A)

Name and title

(B)

Average hours per

week (describe hours for related

organizations in Schedule

O)

(C)

Position (check all that apply)

Individ

ual trustee or d

irector

Institutional trustee

Officer

Key em

ployee

Highest com

pensated em

ployee

Former

(D)

Reportable compensation

from the

organization (W-2/1099-MISC)

(E)

Reportable compensation from

related organizations

(W-2/1099-MISC)

(F)

Estimated amount of

other compensation

from the organization and related

organizations

(17)

(18)

(19)

(20)

(21)

(22)

(23)

(24)

(25)

(26)

(27)

(28)

1b Sub-total . . . . . . . . . . . . . . . . . . . . . c Total from continuation sheets to Part VII, Section A . . . . . d Total (add lines 1b and 1c) . . . . . . . . . . . . . . .

2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organization

Yes No3 Did the organization list any former officer, director or trustee, key employee, or highest compensated

employee on line 1a? If “Yes,” complete Schedule J for such individual . . . . . . . . . . . . 34 For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the

organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person . . . . . . 5

Section B. Independent Contractors1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of

compensation from the organization.

(A) Name and business address

(B) Description of services

(C) Compensation

2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization

Form 990 (2010)

✔ ✔


Form 990 (2010) Page 9 Part VIII Statement of Revenue

Co

ntri

but

ions

, gift

s, g

rant

s an

d o

ther

sim

ilar

amo

unts

(A) Total revenue

(B) Related or

exempt function revenue

(C) Unrelated business revenue

(D) Revenue

excluded from tax under sections

512, 513, or 514

1a Federated campaigns . . . 1a b Membership dues . . . . 1bc Fundraising events . . . . 1c d Related organizations . . . 1de Government grants (contributions) 1e f

All other contributions, gifts, grants, and similar amounts not included above 1f

g Noncash contributions included in lines 1a-1f: $ h Total. Add lines 1a–1f . . . . . . . . .

Prog

ram

Ser

vice

Rev

enue Business Code

2a b c d e f All other program service revenue .g Total. Add lines 2a–2f . . . . . . . . .

Oth

er R

even

ue

3

Investment income (including dividends, interest, and other similar amounts) . . . . . . .

4 Income from investment of tax-exempt bond proceeds 5 Royalties . . . . . . . . . . . . .

6a Gross Rents . .

(i) Real (ii) Personal

b Less: rental expensesc Rental income or (loss)d Net rental income or (loss) . . . . . . .

7a

Gross amount from sales of assets other than inventory

(i) Securities (ii) Other

b

Less: cost or other basis and sales expenses .

c Gain or (loss) . .d Net gain or (loss) . . . . . . . . . .

8a

Gross income from fundraising events (not including $of contributions reported on line 1c). See Part IV, line 18 . . . . . a

b Less: direct expenses . . . . b c Net income or (loss) from fundraising events .

9a

Gross income from gaming activities. See Part IV, line 19 . . . . . a

b Less: direct expenses . . . . b c Net income or (loss) from gaming activities . .

10a

Gross sales of inventory, less returns and allowances . . . a

b Less: cost of goods sold . . . b c Net income or (loss) from sales of inventory . .

Miscellaneous Revenue Business Code

11a bcd All other revenue . . . . .e Total. Add lines 11a–11d . . . . . . . .

12 Total revenue. See instructions. . . . . . Form 990 (2010)

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Form 990 (2010) Page 10 Part IX Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.

(A) Total expenses

(B) Program service

expenses

(C) Management and general expenses

(D) Fundraising expenses

1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 . .

2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 . . . . . .

3

Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 . . . .

4 Benefits paid to or for members . . . .5 Compensation of current officers, directors,

trustees, and key employees . . . . .

6

Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) . .

7 Other salaries and wages . . . . . .8 Pension plan contributions (include section 401(k)

and section 403(b) employer contributions) . .

9 Other employee benefits . . . . . . .10 Payroll taxes . . . . . . . . . . .11 Fees for services (non-employees):

a Management . . . . . . . . . .b Legal . . . . . . . . . . . . .c Accounting . . . . . . . . . . .d Lobbying . . . . . . . . . . . .e Professional fundraising services. See Part IV, line 17 f Investment management fees . . . . .g Other . . . . . . . . . . . . .

12 Advertising and promotion . . . . . .13 Office expenses . . . . . . . . .14 Information technology . . . . . . .15 Royalties . . . . . . . . . . . .16 Occupancy . . . . . . . . . . .17 Travel . . . . . . . . . . . . .18 Payments of travel or entertainment expenses

for any federal, state, or local public officials

19 Conferences, conventions, and meetings .20 Interest . . . . . . . . . . . .21 Payments to affiliates . . . . . . . .22 Depreciation, depletion, and amortization .23 Insurance . . . . . . . . . . . .

24

Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)

a b c d e f All other expenses

25 Total functional expenses. Add lines 1 through 24f 26

Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation . .

Form 990 (2010)


Form 990 (2010) Page 11 Part X Balance Sheet

(A) Beginning of year

(B) End of year

Ass

ets

1 Cash—non-interest-bearing . . . . . . . . . . . . . . 1 2 Savings and temporary cash investments . . . . . . . . . . 2 3 Pledges and grants receivable, net . . . . . . . . . . . . 3 4 Accounts receivable, net . . . . . . . . . . . . . . . 4 5 Receivables from current and former officers, directors, trustees, key

employees, and highest compensated employees. Complete Part II of Schedule L . . . . . . . . . . . . . . . . . . . . 5

6 Receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) . . . . . 6

7 Notes and loans receivable, net . . . . . . . . . . . . . 7 8 Inventories for sale or use . . . . . . . . . . . . . . . 8 9 Prepaid expenses and deferred charges . . . . . . . . . . 9

10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a

b Less: accumulated depreciation . . . . 10b 10c11 Investments—publicly traded securities . . . . . . . . . . 11 12 Investments—other securities. See Part IV, line 11 . . . . . . . 12 13 Investments—program-related. See Part IV, line 11 . . . . . . . 13 14 Intangible assets . . . . . . . . . . . . . . . . . . 14 15 Other assets. See Part IV, line 11 . . . . . . . . . . . . . 15 16 Total assets. Add lines 1 through 15 (must equal line 34) . . . . . 16

Liab

iliti

es

17 Accounts payable and accrued expenses . . . . . . . . . . 17 18 Grants payable . . . . . . . . . . . . . . . . . . . 18 19 Deferred revenue . . . . . . . . . . . . . . . . . . 19 20 Tax-exempt bond liabilities . . . . . . . . . . . . . . . 20 21 Escrow or custodial account liability. Complete Part IV of Schedule D . 21 22 Payables to current and former officers, directors, trustees, key

employees, highest compensated employees, and disqualified persons. Complete Part II of Schedule L . . . . . . . . . . . . . 22

23 Secured mortgages and notes payable to unrelated third parties . . 23 24 Unsecured notes and loans payable to unrelated third parties . . . 24 25 Other liabilities. Complete Part X of Schedule D . . . . . . . . 25 26 Total liabilities. Add lines 17 through 25 . . . . . . . . . . 26

Net

Ass

ets

or

Fund

Bal

ance

s

Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.

27 Unrestricted net assets . . . . . . . . . . . . . . . . 27 28 Temporarily restricted net assets . . . . . . . . . . . . . 28 29 Permanently restricted net assets . . . . . . . . . . . . . 29

Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.

30 Capital stock or trust principal, or current funds . . . . . . . . 30 31 Paid-in or capital surplus, or land, building, or equipment fund . . . 31 32 Retained earnings, endowment, accumulated income, or other funds . 32 33 Total net assets or fund balances . . . . . . . . . . . . . 33 34 Total liabilities and net assets/fund balances . . . . . . . . . 34

Form 990 (2010)


Form 990 (2010) Page 12 Part XI Reconciliation of Net Assets

Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . . . . .

1 Total revenue (must equal Part VIII, column (A), line 12) . . . . . . . . . . . . . . 1 2 Total expenses (must equal Part IX, column (A), line 25) . . . . . . . . . . . . . 2 3 Revenue less expenses. Subtract line 2 from line 1 . . . . . . . . . . . . . . . 3 4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . . . 4 5 Other changes in net assets or fund balances (explain in Schedule O) . . . . . . . . . 5 6 Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33,

column (B)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Part XII Financial Statements and Reporting

Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . . . . .Yes No

1 Accounting method used to prepare the Form 990: Cash Accrual OtherIf the organization changed its method of accounting from a prior year or checked “Other,” explain inSchedule O.

2a Were the organization’s financial statements compiled or reviewed by an independent accountant? . . . 2ab Were the organization’s financial statements audited by an independent accountant? . . . . . . . 2bc If “Yes” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight

of the audit, review, or compilation of its financial statements and selection of an independent accountant? 2cIf the organization changed either its oversight process or selection process during the tax year, explain inSchedule O.

d If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in

the Single Audit Act and OMB Circular A-133? . . . . . . . . . . . . . . . . . . . . . 3ab If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the

required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits 3bForm 990 (2010)


SCHEDULE A (Form 990 or 990-EZ)


Public Charity Status and Public SupportComplete if the organization is a section 501(c)(3) organization or a section

4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. See separate instructions.

OMB No. 1545-0047

2010Open to Public

InspectionName of the organization Employer identification number

Part I Reason for Public Charity Status (All organizations must complete this part.) See instructions.he organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)1 A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

2 A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.) 3 A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).4 A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the

hospital’s name, city, and state:5 An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

6 A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).7 An organization that normally receives a substantial part of its support from a governmental unit or from the general public

described in section 170(b)(1)(A)(vi). (Complete Part II.)

8 A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.) 9 An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businessesacquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

10 An organization organized and operated exclusively to test for public safety. See section 509(a)(4). 11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the

purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

a Type I b Type II c Type III–Functionally integrated d Type III–Othere By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons

other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

f If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Since August 17, 2006, has the organization accepted any gift or contribution from any of thefollowing persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii) below, the governing body of the supported organization? . . . . . . . . . . . . . .

Yes No

11g(i)

(ii) A family member of a person described in (i) above? . . . . . . . . . . . . . . . . . 11g(ii)

(iii) A 35% controlled entity of a person described in (i) or (ii) above? . . . . . . . . . . . . . 11g(iii)

h Provide the following information about the supported organization(s).(i) Name of supported

organization(ii) EIN (iii) Type of organization

(described on lines 1–9 above or IRC section (see instructions))

(iv) Is the organization in col. (i) listed in your governing document?

(v) Did you notify the organization in

col. (i) of your support?

(vi) Is the organization in col. (i) organized in the

U.S.?

(vii) Amount of support

Yes No Yes No Yes No

(A)

(B)

(C)

(D)

(E)

TotalFor Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 11285F Schedule A (Form 990 or 990-EZ) 2010


Schedule A (Form 990 or 990-EZ) 2010 Page 2Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)

(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public SupportCalendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total

1

Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . . .

2

Tax revenues levied for the organization’s benefit and either paid to or expended on its behalf . . .

3

The value of services or facilities furnished by a governmental unit to the organization without charge . . . .

4 Total. Add lines 1 through 3 . . . .

5

The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) . . . .

6 Public support. Subtract line 5 from line 4.Section B. Total SupportCalendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total

7 Amounts from line 4 . . . . . .

8

Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources . . . . . . . . . .

9

Net income from unrelated business activities, whether or not the business is regularly carried on . . . . .

10

Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) . . . . . . .

11 Total support. Add lines 7 through 10 12 Gross receipts from related activities, etc. (see instructions) . . . . . . . . . . . . 1213 First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501(c)(3)

organization, check this box and stop here . . . . . . . . . . . . . . . . . . . . . . . . . Section C. Computation of Public Support Percentage14 Public support percentage for 2010 (line 6, column (f) divided by line 11, column (f)) . . . . 14 %15 Public support percentage from 2009 Schedule A, Part II, line 14 . . . . . . . . . . 15 %16 a 331/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 331/3% or more, check this

box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . . b 331/3% support test—2009. If the organization did not check a box on line 13 or 16a, and line 15 is 331/3% or more,

check this box and stop here. The organization qualifies as a publicly supported organization . . . . . . .

17

a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the “facts-and-circumstances” test, check this box and stop here. Explain in Part IV how the organization meets the “facts-and-circumstances” test. The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the “facts-and-circumstances” test, check this box and stop here. Explain in Part IV how the organization meets the “facts-and-circumstances” test. The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schedule A (Form 990 or 990-EZ) 2010


Page 3Schedule A (Form 990 or 990-EZ) 2010

Part III Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public SupportCalendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total

1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.")

2

Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization’s tax-exempt purpose . . .

3 Gross receipts from activities that are not an unrelated trade or business under section 513

4

Tax revenues levied for the organization’s benefit and either paid to or expended on its behalf . . .

5

The value of services or facilities furnished by a governmental unit to the organization without charge . . . .

6 Total. Add lines 1 through 5 . . . .7a Amounts included on lines 1, 2, and 3

received from disqualified persons .

b

Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year

c Add lines 7a and 7b . . . . . .8 Public support (Subtract line 7c from

line 6.) . . . . . . . . . . .

Section B. Total SupportCalendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total

9 Amounts from line 6 . . . . . .10a

Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources .

b

Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 . . . .

c Add lines 10a and 10b . . . . .11

Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on

12

Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) . . . . . . .

13 Total support. (Add lines 9, 10c, 11, and 12.) . . . . . . . . . .

14 First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here . . . . . . . . . . . . . . . . . . . . . . . . .

Section C. Computation of Public Support Percentage15 Public support percentage for 2010 (line 8, column (f) divided by line 13, column (f)) . . . . . 15 %16 Public support percentage from 2009 Schedule A, Part III, line 15 . . . . . . . . . . . 16 %

Section D. Computation of Investment Income Percentage17 Investment income percentage for 2010 (line 10c, column (f) divided by line 13, column (f)) . . . 17 %18 Investment income percentage from 2009 Schedule A, Part III, line 17 . . . . . . . . . . 18 %19a 331/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 331/3%, and line

17 is not more than 331/3%, check this box and stop here. The organization qualifies as a publicly supported organization .

b 331/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 331/3%, and line 18 is not more than 331/3%, check this box and stop here. The organization qualifies as a publicly supported organization

20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions



Schedule A (Form 990 or 990-EZ) 2010 Page 4Part IV Supplemental Information. Complete this part to provide the explanations required by Part II, line 10;

Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).



Schedule B(Form 990, 990-EZ, or 990-PF)Department of the Treasury Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010Name of the organization Employer identification number

Organization type (check one):

Filers of: Section:

Form 990 or 990-EZ 501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF 501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 331/3 % support test of the regulations under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more during the year . . . . . . . . . . . . . . . . . . . . . . . . . . $

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box on line H of its Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF. Cat. No. 30613X Schedule B (Form 990, 990-EZ, or 990-PF) (2010)


Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page of of Part I

Name of organization Employer identification number

Part I Contributors (see instructions)

(a) No.

(b) Name, address, and ZIP + 4

(c) Aggregate contributions

(d) Type of contribution

$

PersonPayrollNoncash

(Complete Part II if there is a noncash contribution.)

(a) No.




$



(a) No.




$



(a) No.




$



(a) No.




$



(a) No.




$



Schedule B (Form 990, 990-EZ, or 990-PF) (2010)


Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page of of Part II


Part II Noncash Property (see instructions)

(a) No. from Part I

(b) Description of noncash property given

(c) FMV (or estimate)

(see instructions)

(d) Date received

$

(a) No. from Part I



(see instructions)

(d) Date received

$

(a) No. from Part I



(see instructions)

(d) Date received

$

(a) No. from Part I



(see instructions)

(d) Date received

$

(a) No. from Part I



(see instructions)

(d) Date received

$

(a) No. from Part I



(see instructions)

(d) Date received

$



Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page of of Part III


Part III Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations aggregating more than $1,000 for the year. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $

(a) No. from Part I

(b) Purpose of gift (c) Use of gift (d) Description of how gift is held

(e) Transfer of gift

Transferee’s name, address, and ZIP + 4 Relationship of transferor to transferee

(a) No. from Part I




(a) No. from Part I




(a) No. from Part I






SCHEDULE C (Form 990 or 990-EZ)


Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

Complete if the organization is described below. Attach to Form 990 or Form 990-EZ. See separate instructions.

OMB No. 1545-0047

2010Open to Public

InspectionIf the organization answered “Yes,” to Form 990, Part IV, line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then

• Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.

• Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.

• Section 527 organizations: Complete Part I-A only.

If the organization answered “Yes,” to Form 990, Part IV, line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then

• Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.

• Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.

If the organization answered “Yes,” to Form 990, Part IV, line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then

• Section 501(c)(4), (5), or (6) organizations: Complete Part III.Name of organization Employer identification number

Part I-A Complete if the organization is exempt under section 501(c) or is a section 527 organization.1 Provide a description of the organization’s direct and indirect political campaign activities in Part IV.2 Political expenditures . . . . . . . . . . . . . . . . . . . . . . . . . $ 3 Volunteer hours . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part I-B Complete if the organization is exempt under section 501(c)(3).1 Enter the amount of any excise tax incurred by the organization under section 4955 . . . . $ 2 Enter the amount of any excise tax incurred by organization managers under section 4955 . . $ 3 If the organization incurred a section 4955 tax, did it file Form 4720 for this year? . . . . . . . . . Yes No4a Was a correction made? . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes Nob If “Yes,” describe in Part IV.

Part I-C Complete if the organization is exempt under section 501(c), except section 501(c)(3).1 Enter the amount directly expended by the filing organization for section 527 exempt function

activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2 Enter the amount of the filing organization’s funds contributed to other organizations for section

527 exempt function activities . . . . . . . . . . . . . . . . . . . . . . $ 3 Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL,

line 17b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4 Did the filing organization file Form 1120-POL for this year? . . . . . . . . . . . . . . . . Yes No5

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name (b) Address (c) EIN (d) Amount paid from filing organization’s

funds. If none, enter -0-.

(e) Amount of political contributions received and

promptly and directly delivered to a separate political organization. If

none, enter -0-.

(1)

(2)

(3)

(4)

(5)

(6)

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Cat. No. 50084S Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010 Page 2Part II-A Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under

section 501(h)).A Check if the filing organization belongs to an affiliated group.B Check if the filing organization checked box A and “limited control” provisions apply.

Limits on Lobbying Expenditures (The term “expenditures” means amounts paid or incurred.)

(a) Filing organization’s totals

(b) Affiliated group totals

1 a Total lobbying expenditures to influence public opinion (grass roots lobbying) . . . .b Total lobbying expenditures to influence a legislative body (direct lobbying) . . . . .c Total lobbying expenditures (add lines 1a and 1b) . . . . . . . . . . . . .d Other exempt purpose expenditures . . . . . . . . . . . . . . . . . .e Total exempt purpose expenditures (add lines 1c and 1d) . . . . . . . . . . .f Lobbying nontaxable amount. Enter the amount from the following table in both

columns.

If the amount on line 1e, column (a) or (b) is: The lobbying nontaxable amount is:

Not over $500,000 20% of the amount on line 1e.

Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000.

Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000.

Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000.

Over $17,000,000 $1,000,000.

g Grassroots nontaxable amount (enter 25% of line 1f) . . . . . . . . . . . .h Subtract line 1g from line 1a. If zero or less, enter -0- . . . . . . . . . . . .i Subtract line 1f from line 1c. If zero or less, enter -0- . . . . . . . . . . . .j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720

reporting section 4911 tax for this year? . . . . . . . . . . . . . . . . . . . . . . Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five

columns below. See the instructions for lines 2a through 2f on page 4.)

Lobbying Expenditures During 4-Year Averaging Period

Calendar year (or fiscal year beginning in)

(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total

2a Lobbying nontaxable amount

b

Lobbying ceiling amount (150% of line 2a, column (e))

c Total lobbying expenditures

d Grassroots nontaxable amount

e

Grassroots ceiling amount (150% of line 2d, column (e))

f Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010 Page 3Part II-B Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768

(election under section 501(h)).(a) (b)

Yes No Amount

1 During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

a Volunteers? . . . . . . . . . . . . . . . . . . . . . . . . . . . .b Paid staff or management (include compensation in expenses reported on lines 1c through 1i)?c Media advertisements? . . . . . . . . . . . . . . . . . . . . . . . .d Mailings to members, legislators, or the public? . . . . . . . . . . . . . . . .e Publications, or published or broadcast statements? . . . . . . . . . . . . . .f Grants to other organizations for lobbying purposes? . . . . . . . . . . . . . .g Direct contact with legislators, their staffs, government officials, or a legislative body? . . .h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? . .i Other activities? If “Yes,” describe in Part IV . . . . . . . . . . . . . . . . .j Total. Add lines 1c through 1i . . . . . . . . . . . . . . . . . . . . . .

2 a Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? . .b If “Yes,” enter the amount of any tax incurred under section 4912 . . . . . . . . . .c If “Yes,” enter the amount of any tax incurred by organization managers under section 4912 .d If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? . . .

Part III-A Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes No

1 Were substantially all (90% or more) dues received nondeductible by members? . . . . . . . . . 1 2 Did the organization make only in-house lobbying expenditures of $2,000 or less? . . . . . . . . . 2 3 Did the organization agree to carryover lobbying and political expenditures from the prior year? . . . . 3

Part III-B Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes.”

1 Dues, assessments and similar amounts from members . . . . . . . . . . . . . . . 1 2 Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of

political expenses for which the section 527(f) tax was paid).

a Current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a b Carryover from last year . . . . . . . . . . . . . . . . . . . . . . . . . . 2bc Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c

3 Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues . . 3 4 If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the

excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? . . . . . . . . . . . . . . . . . . . . . . 4

5 Taxable amount of lobbying and political expenditures (see instructions) . . . . . . . . . . 5 Part IV Supplemental Information

Complete this part to provide the descriptions required for Part I-A, line 1; Part I-B, line 4; Part I-C, line 5; and Part II-B, line 1i. Also, complete this part for any additional information.



Schedule C (Form 990 or 990-EZ) 2010 Page 4Part IV Supplemental Information (continued)





Supplemental Financial Statements Complete if the organization answered “Yes,” to Form 990,

Part IV, line 6, 7, 8, 9, 10, 11, or 12. Attach to Form 990. See separate instructions.

OMB No. 1545-0047

2010Open to Public Inspection

Name of the organization Employer identification number

Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered “Yes” to Form 990, Part IV, line 6.

(a) Donor advised funds (b) Funds and other accounts

1 Total number at end of year . . . . .2 Aggregate contributions to (during year) .3 Aggregate grants from (during year) . .4 Aggregate value at end of year . . . .5

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? . . . . . . Yes No

6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? . . . . . . . . . . . . . . . . . . . . . . Yes No

Part II Conservation Easements. Complete if the organization answered “Yes” to Form 990, Part IV, line 7.1 Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education)Protection of natural habitatPreservation of open space

Preservation of an historically important land areaPreservation of a certified historic structure

2

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.

Held at the End of the Tax Year

a Total number of conservation easements . . . . . . . . . . . . . . . . . 2ab Total acreage restricted by conservation easements . . . . . . . . . . . . . . 2bc Number of conservation easements on a certified historic structure included in (a) . . . . 2cd Number of conservation easements included in (c) acquired after 8/17/06, and not on a

historic structure listed in the National Register . . . . . . . . . . . . . . . 2d3

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax year

4 Number of states where property subject to conservation easement is located 5

Does the organization have a written policy regarding the periodic monitoring, inspection, handling ofviolations, and enforcement of the conservation easements it holds? . . . . . . . . . . . . . Yes No

6 Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year

7 Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year $

8

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

9

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes the organization’s accounting for conservation easements.

Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. Complete if the organization answered “Yes” to Form 990, Part IV, line 8.

1

a

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance ofpublic service, provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

b

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance ofpublic service, provide the following amounts relating to these items:

(i) Revenues included in Form 990, Part VIII, line 1 . . . . . . . . . . . . . . . . $(ii) Assets included in Form 990, Part X . . . . . . . . . . . . . . . . . . . . $

2

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide thefollowing amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

a Revenues included in Form 990, Part VIII, line 1 . . . . . . . . . . . . . . . . . $b Assets included in Form 990, Part X . . . . . . . . . . . . . . . . . . . . . $

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 52283D Schedule D (Form 990) 2010


Schedule D (Form 990) 2010 Page 2 Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)3

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

a Public exhibitionb Scholarly researchc Preservation for future generations

d Loan or exchange programse Other

4

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in Part XIV.

5

During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets to be sold to raise funds rather than to be maintained as part of the organization’s collection? . . Yes No

Part IV Escrow and Custodial Arrangements. Complete if the organization answered “Yes” to Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

1 a

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included on Form 990, Part X? . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

b If “Yes,” explain the arrangement in Part XIV and complete the following table:Amount

c Beginning balance . . . . . . . . . . . . . . . . . . . . . . 1cd Additions during the year . . . . . . . . . . . . . . . . . . . 1de Distributions during the year . . . . . . . . . . . . . . . . . . 1ef Ending balance . . . . . . . . . . . . . . . . . . . . . . . 1f

2a Did the organization include an amount on Form 990, Part X, line 21? . . . . . . . . . . . . . Yes Nob If “Yes,” explain the arrangement in Part XIV.

Part V Endowment Funds. Complete if the organization answered “Yes” to Form 990, Part IV, line 10.(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back

1a Beginning of year balance . . .b Contributions . . . . . . .c

Net investment earnings, gains, and losses . . . . . . . . . .

d Grants or scholarships . . . .e

Other expenditures for facilities and programs . . . . . . . . .

f Administrative expenses . . . .g End of year balance . . . . .

2 Provide the estimated percentage of the year end balance held as:a Board designated or quasi-endowment %b Permanent endowment %c Term endowment %

3 a

Are there endowment funds not in the possession of the organization that are held and administered for theorganization by: Yes No(i) unrelated organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a(i)(ii) related organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a(ii)

b If “Yes” to 3a(ii), are the related organizations listed as required on Schedule R? . . . . . . . . . 3b4 Describe in Part XIV the intended uses of the organization’s endowment funds.

Part VI Land, Buildings, and Equipment. See Form 990, Part X, line 10.Description of investment (a) Cost or other basis

(investment)(b) Cost or other basis

(other)(c) Accumulated

depreciation(d) Book value

1a Land . . . . . . . . . . .b Buildings . . . . . . . . . .c Leasehold improvements . . . .d Equipment . . . . . . . . .e Other . . . . . . . . . . .

Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).) . . . .



Schedule D (Form 990) 2010 Page 3 Part VII Investments—Other Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)

(b) Book value (c) Method of valuation: Cost or end-of-year market value

(1) Financial derivatives . . . . . . . .(2) Closely-held equity interests . . . . . .(3) Other

(A)

(B)

(C)

(D)

(E)(F)(G)

(H)

(I)

Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII Investments—Program Related. See Form 990, Part X, line 13.(a) Description of investment type (b) Book value (c) Method of valuation:

Cost or end-of-year market value

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)Total. (Column (b) must equal Form 990, Part X, col. (B) line 13.) Part IX Other Assets. See Form 990, Part X, line 15.

(a) Description (b) Book value

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)Total. (Column (b) must equal Form 990, Part X, col. (B) line 15.) . . . . . . . . . . . . . .

Part X Other Liabilities. See Form 990, Part X, line 25.1. (a) Description of liability (b) Amount

(1) Federal income taxes(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

Total. (Column (b) must equal Form 990, Part X, col. (B) line 25.) 2. FIN 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization’s financial statements that reports the organization’s liability for uncertain tax positions under FIN 48 (ASC 740).



Schedule D (Form 990) 2010 Page 4 Part XI Reconciliation of Change in Net Assets from Form 990 to Audited Financial Statements1 Total revenue (Form 990, Part VIII, column (A), line 12) . . . . . . . . . . . . . . 12 Total expenses (Form 990, Part IX, column (A), line 25) . . . . . . . . . . . . . . 23 Excess or (deficit) for the year. Subtract line 2 from line 1 . . . . . . . . . . . . . 34 Net unrealized gains (losses) on investments . . . . . . . . . . . . . . . . . 45 Donated services and use of facilities . . . . . . . . . . . . . . . . . . . 56 Investment expenses . . . . . . . . . . . . . . . . . . . . . . . . . 67 Prior period adjustments . . . . . . . . . . . . . . . . . . . . . . . . 78 Other (Describe in Part XIV.) . . . . . . . . . . . . . . . . . . . . . . . 89 Total adjustments (net). Add lines 4 through 8 . . . . . . . . . . . . . . . . . 9

10 Excess or (deficit) for the year per audited financial statements. Combine lines 3 and 9 . . . 10Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return

1 Total revenue, gains, and other support per audited financial statements . . . . . . . . 12 Amounts included on line 1 but not on Form 990, Part VIII, line 12:

a Net unrealized gains on investments . . . . . . . . . . . . 2ab Donated services and use of facilities . . . . . . . . . . . 2bc Recoveries of prior year grants . . . . . . . . . . . . . . 2cd Other (Describe in Part XIV.) . . . . . . . . . . . . . . . 2de Add lines 2a through 2d . . . . . . . . . . . . . . . . . . . . . . . . . 2e

3 Subtract line 2e from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 34 Amounts included on Form 990, Part VIII, line 12, but not on line 1 :

a Investment expenses not included on Form 990, Part VIII, line 7b . . 4ab Other (Describe in Part XIV.) . . . . . . . . . . . . . . . 4bc Add lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . . . . . 4c

5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) . . . . . . . 5Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return

1 Total expenses and losses per audited financial statements . . . . . . . . . . . . . 12 Amounts included on line 1 but not on Form 990, Part IX, line 25:

a Donated services and use of facilities . . . . . . . . . . . 2ab Prior year adjustments . . . . . . . . . . . . . . . . 2bc Other losses . . . . . . . . . . . . . . . . . . . . 2cd Other (Describe in Part XIV.) . . . . . . . . . . . . . . . 2de Add lines 2a through 2d . . . . . . . . . . . . . . . . . . . . . . . . . 2e

3 Subtract line 2e from line 1 . . . . . . . . . . . . . . . . . . . . . . . . 34 Amounts included on Form 990, Part IX, line 25, but not on line 1:

a Investment expenses not included on Form 990, Part VIII, line 7b . . 4ab Other (Describe in Part XIV.) . . . . . . . . . . . . . . . 4bc Add lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . . . . . 4c

5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) . . . . . . . 5Part XIV Supplemental InformationComplete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.



Schedule D (Form 990) 2010 Page 5 Part XIV Supplemental Information (continued)



SCHEDULE E (Form 990 or 990-EZ)


Schools Complete if the organization answered “Yes” to Form 990, Part IV, line 13, or

Form 990-EZ, Part VI, line 48. Attach to Form 990 or Form 990-EZ.

OMB No. 1545-0047



Part IYES NO

1 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing instrument, or in a resolution of its governing body? . . . . . . . . . . 1

2

Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships? . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3

Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves? If “Yes,” pleasedescribe. If “No,” please explain. If you need more space, use Part II . . . . . . . . . . . . . 3

4 Does the organization maintain the following?a Records indicating the racial composition of the student body, faculty, and administrative staff? . . . . 4ab

Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4b

c

Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships? . . . . . . . . . . . . . . . . . . 4c

d Copies of all material used by the organization or on its behalf to solicit contributions? . . . . . . . 4dIf you answered “No” to any of the above, please explain. If you need more space, use Part II.

5 Does the organization discriminate by race in any way with respect to:a Students’ rights or privileges? . . . . . . . . . . . . . . . . . . . . . . . . . . 5a

b Admissions policies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5b

c Employment of faculty or administrative staff? . . . . . . . . . . . . . . . . . . . . . 5c

d Scholarships or other financial assistance? . . . . . . . . . . . . . . . . . . . . . . 5d

e Educational policies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5e

f Use of facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5f

g Athletic programs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5g

h Other extracurricular activities? . . . . . . . . . . . . . . . . . . . . . . . . . 5hIf you answered “Yes” to any of the above, please explain. If you need more space, use Part II.

6a Does the organization receive any financial aid or assistance from a governmental agency? . . . . . . 6ab Has the organization’s right to such aid ever been revoked or suspended? . . . . . . . . . . . 6b

If you answered “Yes” to either line 6a or line 6b, explain on Part II.7 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through

4.05 of Rev. Proc. 75-50, 1975-2 C.B. 587, covering racial nondiscrimination? If “No,” explain on Part II . . 7For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ. Cat. No. 50085D Schedule E (Form 990 or 990-EZ) (2010)


Schedule E (Form 990 or 990-EZ) (2010) Page 2Part II Supplemental Information. Complete this part to provide the explanations required by Part I, lines 3, 4d, 5h,

6b, and 7, as applicable. Also complete this part to provide any other additional information (see instructions).

Schedule E (Form 990 or 990-EZ) (2010)




Statement of Activities Outside the United States Complete if the organization answered "Yes" to Form 990,

Part IV, line 14b, 15, or 16.

Attach to Form 990. See separate instructions.

OMB No. 1545-0047



Part I General Information on Activities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 14b.

1 For grantmakers. Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used to award thegrants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

2 For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside the United States.

3 Activities per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.) (a) Region (b) Number of

offices in the region

(c) Number of employees, agents,

and independent contractors

in region

(d) Activities conducted in region (by type) (e.g., fundraising, program

services, investments, grants to recipients

located in the region)

(e) If activity listed in (d) is a program service,

describe specific type of service(s) in region

(f) Total expenditures for and investments

in region

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

(17)3 a Sub-total . . . . . .b Total from continuation

sheets to Part I . . . .

c Totals (add lines 3a and 3b) For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50082W Schedule F (Form 990) 2010


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Schedule F (Form 990) 2010 Page 4Part IV Foreign Forms

1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a ForeignCorporation (see Instructions for Form 926) . . . . . . . . . . . . . . . . . . . . Yes No

2 Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organizationmay be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A) . . . . . . . . . . . . . . . Yes No

3

Did the organization have an ownership interest in a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see Instructions for Form 5471) . . . . . . . . . . . . . Yes No

4

Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (seeInstructions for Form 8621) . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

5

Did the organization have an ownership interest in a foreign partnership during the tax year? If “Yes,”the organization may be required to file Form 8865, Return of U.S. Persons with respect to CertainForeign Partnerships. (see Instructions for Form 8865) . . . . . . . . . . . . . . . . Yes No

6

Did the organization have any operations in or related to any boycotting countries during the tax year? If“Yes,” the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No



Schedule F (Form 990) 2010 Page 5 Part V Supplemental Information

Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).



SCHEDULE G (Form 990 or 990-EZ)Department of the Treasury Internal Revenue Service

Supplemental Information Regarding Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Attach to Form 990 or Form 990-EZ. See separate instructions.

OMB No. 1545-0047



Part I Fundraising Activities. Complete if the organization answered “Yes” to Form 990, Part IV, line 17. Form 990-EZ filers are not required to complete this part.

1 Indicate whether the organization raised funds through any of the following activities. Check all that apply.a Mail solicitationsb Internet and email solicitationsc Phone solicitationsd In-person solicitations

e Solicitation of non-government grantsf Solicitation of government grantsg Special fundraising events

2 a

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? Yes No

b

If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to becompensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)

(ii) Activity(iii) Did fundraiser have custody or control of

contributions?

(iv) Gross receipts from activity

(v) Amount paid to (or retained by)

fundraiser listed in col. (i)

(vi) Amount paid to (or retained by)

organization

Yes No 1

2

3

4

5

6

7

8

9

10

Total . . . . . . . . . . . . . . . . . . . . .3

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt fromregistration or licensing.

Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Cat. No. 50083H Schedule G (Form 990 or 990-EZ) 2010


Schedule G (Form 990 or 990-EZ) 2010 Page 2Part II Fundraising Events. Complete if the organization answered “Yes” to Form 990, Part IV, line 18, or reported more

than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

Rev

enue

(a) Event #1

(event type)

(b) Event #2

(event type)

(c) Other events

(total number)

(d) Total events (add col. (a) through

col. (c))

1 Gross receipts . . . .2

Less: Charitable contributions . . . .

3

Gross income (line 1 minus line 2) . . . . . . .

Dire

ct E

xpen

ses

4 Cash prizes . . . . .

5 Noncash prizes . . .

6 Rent/facility costs . . .

7 Food and beverages . .

8 Entertainment . . . .

9 Other direct expenses .

10 Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . . ( )11 Net income summary. Combine line 3, column (d), and line 10 . . . . . . . . . .

Part III Gaming. Complete if the organization answered “Yes” to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

Rev

enue (a) Bingo

(b) Pull tabs/instant bingo/progressive bingo

(c) Other gaming(d) Total gaming (add

col. (a) through col. (c))

1 Gross revenue . . . .

Dire

ct E

xpen

ses

2 Cash prizes . . . . .

3 Noncash prizes . . .

4 Rent/facility costs . . .

5 Other direct expenses .

6 Volunteer labor . . . .

Yes % Yes % Yes %No No No

7 Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . ( )

8 Net gaming income summary. Combine line 1, column d, and line 7 . . . . . . . .

9 Enter the state(s) in which the organization operates gaming activities:a Is the organization licensed to operate gaming activities in each of these states? . . . . . . . . . Yes Nob If “No,” explain:

10a Were any of the organization’s gaming licenses revoked, suspended or terminated during the tax year? . Yes Nob If “Yes,” explain:

Schedule G (Form 990 or 990-EZ) 2010


Schedule G (Form 990 or 990-EZ) 2010 Page 3

13 Indicate the percentage of gaming activity operated in:a The organization’s facility . . . . . . . . . . . . . . . . . . . . . . . . . 13a %b An outside facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13b %

14

Enter the name and address of the person who prepares the organization’s gaming/special events books and records:

Name

Address

15a Does the organization have a contract with a third party from whom the organization receives gaming revenue? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

b If “Yes,” enter the amount of gaming revenue received by the organization $ and theamount of gaming revenue retained by the third party $ .

c If “Yes,” enter name and address of the third party:

Name

Address

16 Gaming manager information:

Name

Gaming manager compensation $

Description of services provided

Director/officer Employee Independent contractor

17 Mandatory distributions:a

Is the organization required under state law to make charitable distributions from the gaming proceeds to retain the state gaming license? . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

b

Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the organization’s own exempt activities during the tax year $

Part IV Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Schedule G (Form 990 or 990-EZ) 2010

11 Does the organization operate gaming activities with nonmembers? . . . . . . . . . . . . . Yes No12

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity formed to administer charitable gaming? . . . . . . . . . . . . . . . . . . . . . . Yes No


SCHEDULE H (Form 990)


Hospitals Complete if the organization answered “Yes” to Form 990, Part IV, question 20.


OMB No. 1545-0047



Part I Financial Assistance and Certain Other Community Benefits at CostYes No

1a Did the organization have a financial assistance policy during the tax year? If “No,” skip to question 6a . 1ab If “Yes,” was it a written policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b

2

If the organization had multiple hospital facilities, indicate which of the following best describes application ofthe financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

3

Answer the following based on the financial assistance eligibility criteria that applied to the largest number ofthe organization’s patients during the tax year.

a

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low income individuals? If “Yes,” indicate which of the following was the FPG family income limit for eligibility for free care: . . 3a

100% 150% 200% Other %b

Did the organization use FPG to determine eligibility for providing discounted care to low income individuals? If “Yes,” indicate which of the following was the family income limit for eligibility for discounted care: . . . . . 3b

200% 250% 300% 350% 400% Other %c

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

4 Did the organization’s financial assistance policy that applied to the largest number of its patients during thetax year provide for free or discounted care to the “medically indigent”? . . . . . . . . . . . . 4

5a Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? 5ab If “Yes,” did the organization’s financial assistance expenses exceed the budgeted amount? . . . . . 5bc

If “Yes” to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted care to a patient who was eligible for free or discounted care? . . . . . . . . . . . 5c

6a Did the organization prepare a community benefit report during the tax year? . . . . . . . . . . 6ab If “Yes,” did the organization make it available to the public? . . . . . . . . . . . . . . . . 6b

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

7 Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government

Programs

(a) Number of activities or programs (optional)

(b) Persons served

(optional)

(c) Total community benefit expense

(d) Direct offsetting revenue

(e) Net community benefit expense

(f) Percent of total

expense

a

Financial Assistance at cost (from Worksheets 1 and 2) . .

b

Unreimbursed Medicaid (from Worksheet 3, column a) . . .

c

Unreimbursed costs—other means- tested government programs (from Worksheet 3, column b) . . . .

d Total Financial Assistance and Means-Tested Government Programs . . . . . . .

Other Benefitse

Community health improvement services and community benefit operations (from Worksheet 4) .

f

Health professions education (from Worksheet 5) . . . .

g

Subsidized health services (from Worksheet 6) . . . . . .

h Research (from Worksheet 7) .i

Cash and in-kind contributions to community groups (from Worksheet 8) . . . . . .

j Total. Other Benefits . . . .k Total. Add lines 7d and 7j . .

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010


Schedule H (Form 990) 2010 Page 2 Part II Community Building Activities Complete this table if the organization conducted any community building

activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

(a) Number of activities or programs (optional)

(b) Persons served

(optional)

(c) Total community building expense

(d) Direct offsetting revenue

(e) Net community building expense

(f) Percent of total expense

1 Physical improvements and housing

2 Economic development

3 Community support

4 Environmental improvements5

Leadership development and training for community members

6 Coalition building7

Community health improvement advocacy

8 Workforce development

9 Other

10 TotalPart III Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt ExpenseYes No

1

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Enter the amount of the organization’s bad debt expense (at cost) . . . . . . . . 23

Enter the estimated amount of the organization’s bad debt expense (at cost) attributableto patients eligible under the organization’s financial assistance policy . . . . . . . 3

4

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare5 Enter total revenue received from Medicare (including DSH and IME) . . . . . . . 56 Enter Medicare allowable costs of care relating to payments on line 5 . . . . . . . 67 Subtract line 6 from line 5. This is the surplus (or shortfall) . . . . . . . . . . . 78

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit. Also describe in Part VI the costing methodology or source used to determine the amount reportedon line 6. Check the box that describes the method used:

Cost accounting system Cost to charge ratio OtherSection C. Collection Practices

9a Did the organization have a written debt collection policy during the tax year? . . . . . . . . . . 9ab If “Yes,” did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions

on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI . . . 9bPart IV Management Companies and Joint Ventures

(a) Name of entity (b) Description of primary activity of entity

(c) Organization’s profit % or stock

ownership %

(d) Officers, directors, trustees, or key

employees’ profit % or stock ownership %

(e) Physicians’ profit % or stock

ownership %

123456789

10111213



Schedule H (Form 990) 2010 Page 3 Part V Facility Information

Section A. Hospital Facilities(list in order of size, measured by total revenue per facility, from largest to smallest)

How many hospital facilities did the organization operate during the tax year?

Licensed hosp

ital

General m

edical &

surgical

Child

ren’s hospital

Teaching hospital

Critical access hosp

ital

Research facility

ER

–24 hours

ER

–other

Name and address Other (describe)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16


✔


Schedule H (Form 990) 2010 Page 4 Part V Facility Information (continued)

Section B. Facility Policies and Practices(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):Yes No

Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs

assessment (Needs Assessment)? If "No," skip to line 8 . . . . . . . . . . . . . . . . . 1If “Yes,” indicate what the Needs Assessment describes (check all that apply):

a A definition of the community served by the hospital facility b Demographics of the community c Existing health care facilities and resources within the community that are available to respond to the

health needs of the community d How data was obtained e The health needs of the community f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons,

and minority groups g The process for identifying and prioritizing community health needs and services to meet the

community health needs h The process for consulting with persons representing the community's interests i Information gaps that limit the hospital facility's ability to assess all of the community's health needsj Other (describe in Part VI)

2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 203 In conducting its most recent Needs Assessment, did the hospital facility take into account input from

persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how thehospital facility took into account input from persons who represent the community, and identify the personsthe hospital facility consulted . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Was the hospital facility's Needs Assessment conducted with one or more other hospital facilities? If "Yes,"list the other hospital facilities in Part VI . . . . . . . . . . . . . . . . . . . . . . . 4

5 Did the hospital facility make its Needs Assessment widely available to the public? . . . . . . . . 5If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):

a Hospital facility's website b Available upon request from the hospital facilityc Other (describe in Part VI)

6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):

a Adoption of an implementation strategy to address the health needs of the hospital facility's communityb Execution of the implementation strategyc Participation in the development of a community-wide community benefit pland Participation in the execution of a community-wide community benefit plane Inclusion of a community benefit section in operational plansf Adoption of a budget for provision of services that address the needs identified in the Needs Assessmentg Prioritization of health needs in its communityh Prioritization of services that the hospital facility will undertake to meet health needs in its communityi Other (describe in Part VI)

7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment?If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Financial Assistance PolicyDid the hospital facility have in place during the tax year a written financial assistance policy that:

8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discountedcare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 If “Yes,” indicate the FPG family income limit for eligibility for free care: %



Schedule H (Form 990) 2010 Page 5Part V Facility Information (continued)

Yes No

10 Used FPG to determine eligibility for providing discounted care to low income individuals? . . . . . . . . . 10 If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %

11 Explained the basis for calculating amounts charged to patients? . . . . . . . . . . . . . . 11If “Yes,” indicate the factors used in determining such amounts (check all that apply):

a Income levelb Asset levelc Medical indigencyd Insurance statuse Uninsured discountf Medicaid/Medicareg State regulationh Other (describe in Part VI)

12 Explained the method for applying for financial assistance? . . . . . . . . . . . . . . . . 12 13 Included measures to publicize the policy within the community served by the hospital facility? . . . . 13

If “Yes,” indicate how the hospital facility publicized the policy (check all that apply): a The policy was posted on the hospital facility's websiteb The policy was attached to billing invoicesc The policy was posted in the hospital facility's emergency rooms or waiting roomsd The policy was posted in the hospital facility's admissions officese The policy was provided, in writing, to patients on admission to the hospital facilityf The policy was available on requestg Other (describe in Part VI)

Billing and Collections

14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a writtenfinancial assistance policy that explained actions the hospital facility may take upon non-payment? . . . 14

15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:

a Reporting to credit agencyb Lawsuitsc Liens on residencesd Body attachmentse Other actions (describe in Part VI)

16 Did the hospital facility engage in or authorize a third party to perform any of the following collection actionsduring the tax year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):

a Reporting to credit agencyb Lawsuitsc Liens on residencesd Body attachments e Other actions (describe in Part VI)

17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in line16 (check all that apply):

a Notified patients of the financial assistance policy on admissionb Notified patients of the financial assistance policy prior to dischargec Notified patients of the financial assistance policy in communications with the patients regarding the

patients' billsd Documented its determination of whether a patient who applied for financial assistance under the

financial assistance policy qualified for financial assistancee Other (describe in Part VI)



Schedule H (Form 990) 2010 Page 6Part V Facility Information (continued)Policy Relating to Emergency Medical Care

Yes No

18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility's financial assistance policy? . . . . 18If “No,” indicate the reasons why (check all that apply):

a The hospital facility did not provide care for any emergency medical conditionsb The hospital facility did not have a policy relating to emergency medical carec The hospital facility limited who was eligible to receive care for emergency medical conditions (describe

in Part VI)

d Other (describe in Part VI)Charges for Medical Care

19 Indicate how the hospital facility determined the amounts billed to individuals who did not have insurancecovering emergency or other medically necessary care (check all that apply):

a The hospital facility used the lowest negotiated commercial insurance rate for those services at thehospital facility

b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility

c The hospital facility used the Medicare rate for those servicesd Other (describe in Part VI)

20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility's financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20If “Yes,” explain in Part VI.

21 Did the hospital facility charge any of its patients an amount equal to the gross charge for any service provided to that patient? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 If “Yes,” explain in Part VI.



Schedule H (Form 990) 2010 Page 7 Part V Facility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest)

How many non-hospital facilities did the organization operate during the tax year?

Name and address Type of Facility (describe)

1

2

3

4

5

6

7

8

9

10



Schedule H (Form 990) 2010 Page 8 Part VI Supplemental Information

Complete this part to provide the following information.

1

Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.

2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.

3

Patient education of eligibility for assistance. Describe how the organization informs and educates patients and personswho may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.

4

Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.

5

Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).

6

Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of theorganization and its affiliates in promoting the health of the communities served.

7

State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.



SC

HE

DU

LE I

(Fo

rm 9

90)

Dep

artm

ent

of t

he T

reas

ury

In

tern

al R

even

ue S

ervi

ce

Gra

nts

and

Oth

er A

ssis

tanc

e to

Org

aniz

atio

ns,

Gov

ernm

ents

, an

d In

divi

dual

s in

the

Uni

ted

Sta

tes

Co

mp

lete

if t

he o

rgan

izat

ion

answ

ered

“Y

es”

to F

orm

990

, Par

t IV

, lin

e 21

or

22.

Att

ach

to F

orm

990

.

OM

B N

o. 1

545-

0047

2010

Op

en t

o P

ublic

In

spec

tio

nN

ame

of t

he o

rgan

izat

ion

Em

plo

yer

iden

tific

atio

n nu

mb

er

Par

t I

Gen

eral

Info

rmat

ion

on

Gra

nts

and

Ass

ista

nce

1 D

oes

the

orga

niza

tion

mai

ntai

n re

cord

s to

sub

stan

tiate

the

am

ount

of t

he g

rant

s or

ass

ista

nce,

the

gra

ntee

s’ e

ligib

ility

for

the

gran

ts o

r as

sist

ance

, and

th

e se

lect

ion

crite

ria u

sed

to

awar

d t

he g

rant

s or

ass

ista

nce?

.

..

..

..

..

..

..

..

..

..

..

..

..

..

..

Yes

N

o

2 D

escr

ibe

in P

art

IV t

he o

rgan

izat

ion’

s p

roce

dur

es fo

r m

onito

ring

the

use

of g

rant

fund

s in

the

Uni

ted

Sta

tes.

P

art

II G

rant

s an

d O

ther

Ass

ista

nce

to G

ove

rnm

ents

and

Org

aniz

atio

ns in

the

Uni

ted

Sta

tes.

Com

ple

te if

the

org

aniz

atio

n an

swer

ed “

Yes

” to

Fo

rm 9

90, P

art

IV, l

ine

21, f

or a

ny r

ecip

ient

tha

t re

ceiv

ed m

ore

than

$5,

000.

Che

ck t

his

box

if n

o on

e re

cip

ient

rec

eive

d m

ore

than

$5,

000.

Par

t II

can

be

dup

licat

ed if

ad

diti

onal

sp

ace

is n

eed

ed .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.

1 (a

) Nam

e an

d a

dd

ress

of o

rgan

izat

ion

or

gov

ernm

ent

(b) E

IN

(c) I

RC

sec

tion

if

ap

plic

able

(d

) Am

ount

of c

ash

gran

t (e

) Am

ount

of n

on-

cash

ass

ista

nce

(f) M

etho

d o

f val

uatio

n (b

ook,

FM

V, a

pp

rais

al,

othe

r)

(g) D

escr

iptio

n of

no

n-ca

sh a

ssis

tanc

e (h

) Pur

pos

e of

gra

nt

or a

ssis

tanc

e

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12) 2

Ent

er t

otal

num

ber

of s

ectio

n 50

1(c)

(3) a

nd g

over

nmen

t or

gani

zatio

ns.

..

..

..

..

..

..

..

..

..

..

..

..

.

3 E

nter

tot

al n

umb

er o

f oth

er o

rgan

izat

ions

.

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

For

Pap

erw

ork

Red

ucti

on

Act

No

tice

, see

the

Inst

ruct

ions

fo

r Fo

rm 9

90.

Cat

. No.

500

55P

Sch

edul

e I (

Form

990

) (20

10)


Sch

edul

e I (

Form

990

) (20

10)

Pag

e 2

Par

t III

G

rant

s an

d O

ther

Ass

ista

nce

to In

div

idua

ls in

the

Uni

ted

Sta

tes.

Com

ple

te if

the

org

aniz

atio

n an

swer

ed “

Yes

” to

For

m 9

90, P

art

IV, l

ine

22.

P

art

III c

an b

e d

uplic

ated

if a

dd

ition

al s

pac

e is

nee

ded

. (a

) Typ

e of

gra

nt o

r as

sist

ance

(b

) Num

ber

of

reci

pie

nts

(c) A

mou

nt o

f

cash

gra

nt

(d) A

mou

nt o

f

non-

cash

ass

ista

nce

(e) M

etho

d o

f val

uatio

n (b

ook,

FM

V, a

pp

rais

al, o

ther

) (f

) Des

crip

tion

of n

on-c

ash

assi

stan

ce

1 2 3 4 5 6 7P

art

IV

Sup

ple

men

tal I

nfo

rmat

ion.

Com

ple

te t

his

par

t to

pro

vid

e th

e in

form

atio

n re

qui

red

in P

art

I, lin

e 2,

and

any

oth

er a

dd

ition

al in

form

atio

n.

Sch

edul

e I (

Form

990

) (20

10)


SCHEDULE J (Form 990)


Compensation InformationFor certain Officers, Directors, Trustees, Key Employees, and Highest

Compensated Employees Complete if the organization answered "Yes" to Form 990,

Part IV, line 23. Attach to Form 990. See separate instructions.

OMB No. 1545-0047

2010Open to Public


Part I Questions Regarding CompensationYes No

1a Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form 990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal useTravel for companions Payments for business use of personal residenceTax indemnification and gross-up payments Health or social club dues or initiation feesDiscretionary spending account Personal services (e.g., maid, chauffeur, chef)

b If any of the boxes on line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If “No,” complete Part III to explain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b

2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? . . . . . 2

3 Indicate which, if any, of the following the organization uses to establish the compensation of the organization’s CEO/Executive Director. Check all that apply.

Compensation committee Written employment contractIndependent compensation consultant Compensation survey or studyForm 990 of other organizations Approval by the board or compensation committee

4 During the year, did any person listed in Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

a Receive a severance payment or change-of-control payment from the organization or a related organization? 4ab Participate in, or receive payment from, a supplemental nonqualified retirement plan? . . . . . . . 4bc Participate in, or receive payment from, an equity-based compensation arrangement? . . . . . . . 4c

If “Yes” to any of lines 4a–c, list the persons and provide the applicable amounts for each item in Part III.

Only section 501(c)(3) and 501(c)(4) organizations must complete lines 5–9.5 For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any

compensation contingent on the revenues of:

a The organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5ab Any related organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . 5b

If “Yes” to line 5a or 5b, describe in Part III.6 For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any

compensation contingent on the net earnings of:

a The organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6ab Any related organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . 6b

If “Yes” to line 6a or 6b, describe in Part III.7 For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed

payments not described in lines 5 and 6? If “Yes,” describe in Part III . . . . . . . . . . . . . 78 Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject

to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If “Yes,” describein Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

9 If “Yes” to line 8, did the organization also follow the rebuttable presumption procedure described inRegulations section 53.4958-6(c)? . . . . . . . . . . . . . . . . . . . . . . . . 9

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50053T Schedule J (Form 990) 2010


Sch

edul

e J

(For

m 9

90) 2

010

Pag

e 2

Par

t II

Off

icer

s, D

irec

tors

, Tru

stee

s, K

ey E

mp

loye

es, a

nd H

ighe

st C

om

pen

sate

d E

mp

loye

es. U

se d

uplic

ate

cop

ies

if ad

diti

onal

sp

ace

is n

eed

ed.

For

each

ind

ivid

ual w

hose

com

pen

satio

n m

ust

be

rep

orte

d in

Sch

edul

e J,

rep

ort

com

pen

satio

n fr

om t

he o

rgan

izat

ion

on r

ow (

i) an

d f

rom

rel

ated

org

aniz

atio

ns,

des

crib

ed in

the

in

stru

ctio

ns, o

n ro

w (i

i). D

o no

t lis

t an

y in

div

idua

ls t

hat

are

not

liste

d o

n Fo

rm 9

90, P

art

VII.

No

te. T

he s

um o

f col

umns

(B)(i

)–(ii

i) m

ust

equa

l the

ap

plic

able

col

umn

(D) o

r co

lum

n (E

) am

ount

s on

For

m 9

90, P

art

VII,

line

1a.

(A) N

ame

(i) B

ase

com

pen

satio

n(ii

) Bon

us &

ince

ntiv

e co

mp

ensa

tion

(iii)

Oth

er

rep

orta

ble

co

mp

ensa

tion

(C) R

etire

men

t an

d

othe

r d

efer

red

co

mp

ensa

tion

(D) N

onta

xab

le

ben

efits

(E) T

otal

of c

olum

ns

(B)(i

)–(D

)(F

) Com

pen

satio

n re

por

ted

in p

rior

Form

990

or

Form

990

-EZ

1

(i)

(ii)

2

(i)

(ii)

3

(i)

(ii)

4

(i)

(ii)

5

(i)

(ii)

6

(i)

(ii)

7

(i)

(ii)

8

(i)

(ii)

9

(i)

(ii)

10

(i)

(ii)

11

(i)

(ii)

12

(i)

(ii)

13

(i)

(ii)

14

(i)

(ii)

15

(i)

(ii)

16

(i)

(ii)

(B) B

reak

dow

n of

W-2

and

/or

1099

-MIS

C c

omp

ensa

tion

Sch

edul

e J

(Fo

rm 9

90) 2

010

✔✔

✔✔

✔✔

✔


Sch

edul

e J

(For

m 9

90) 2

010

Pag

e 3

Par

t III

Sup

ple

men

tal I

nfo

rmat

ion

Com

ple

te t

his

par

t to

pro

vid

e th

e in

form

atio

n, e

xpla

natio

n, o

r d

escr

iptio

ns r

equi

red

for

Par

t I,

lines

1a,

1b

, 4c,

5a,

5b

, 6a,

6b

, 7, a

nd 8

. Als

o co

mp

lete

thi

s p

art

for

any

add

ition

al in

form

atio

n.

Sch

edul

e J

(Fo

rm 9

90) 2

010


SC

HE

DU

LE K

(F

orm

990

)

Dep

artm

ent

of t

he T

reas

ury

In

tern

al R

even

ue S

ervi

ce

Sup

plem

enta

l Inf

orm

atio

n on

Tax

-Exe

mpt

Bon

ds C

om

ple

te if

the

org

aniz

atio

n an

swer

ed “

Yes

” to

Fo

rm 9

90, P

art

IV, l

ine

24a.

Pro

vid

e d

escr

ipti

ons

, ex

pla

nati

ons

, and

any

ad

dit

iona

l inf

orm

atio

n in

Par

t V

. A

ttac

h to

Fo

rm 9

90.

See

sep

arat

e in

stru

ctio

ns.

OM

B N

o. 1

545-

0047

2010

Op

en t

o P

ublic

In

spec

tio

nN

ame

of t

he o

rgan

izat

ion

Em

plo

yer

iden

tific

atio

n nu

mb

er

Par

t I

Bo

nd Is

sues

(a) I

ssue

r na

me

(b) I

ssue

r E

IN(c

) CU

SIP

#(d

) Dat

e is

sued

(e) I

ssue

pric

e(f

) Des

crip

tion

of p

urp

ose

(g) D

efea

sed

(h) O

n be

half

of

issu

er

(i) P

oole

d fin

anci

ng

Yes

No

Yes

No

Yes

No

A B C D Par

t II

Pro

ceed

sA

BC

D1

Am

ount

of b

ond

s re

tired

..

..

..

..

..

..

..

..

..

2A

mou

nt o

f bon

ds

lega

lly d

efea

sed

.

..

..

..

..

..

..

.3

Tota

l pro

ceed

s of

issu

e .

..

..

..

..

..

..

..

..

. 4

Gro

ss p

roce

eds

in r

eser

ve fu

nds

..

..

..

..

..

..

..

.5

Cap

italiz

ed in

tere

st fr

om p

roce

eds

..

..

..

..

..

..

..

6P

roce

eds

in r

efun

din

g es

crow

s.

..

..

..

..

..

..

..

. 7

Issu

ance

cos

ts fr

om p

roce

eds

..

..

..

..

..

..

..

..

8C

red

it en

hanc

emen

t fr

om p

roce

eds

..

..

..

..

..

..

..

9W

orki

ng c

apita

l exp

end

iture

s fr

om p

roce

eds

..

..

..

..

..

.

10

Cap

ital e

xpen

ditu

res

from

pro

ceed

s .

..

..

..

..

..

..

.11

Oth

er s

pen

t p

roce

eds

..

..

..

..

..

..

..

..

..

.12

Oth

er u

nsp

ent

pro

ceed

s .

..

..

..

..

..

..

..

..

.

13Y

ear

of s

ubst

antia

l com

ple

tion

..

..

..

..

..

..

..

..

Yes

No

Yes

No

Yes

No

Yes

No

14W

ere

the

bon

ds

issu

ed a

s p

art

of a

cur

rent

ref

und

ing

issu

e?

..

..

..

15

Wer

e th

e b

ond

s is

sued

as

par

t of

an

adva

nce

refu

ndin

g is

sue?

..

..

. 1

6H

as t

he fi

nal a

lloca

tion

of p

roce

eds

bee

n m

ade?

..

..

..

..

..

17

Doe

s th

e or

gani

zatio

n m

aint

ain

adeq

uate

boo

ks a

nd r

ecor

ds

to s

upp

ort

the

final

allo

catio

n of

pro

ceed

s?

..

..

..

..

..

..

..

..

Par

t III

Pri

vate

Bus

ines

s U

seA

BC

DY

esN

oY

esN

oY

esN

oY

esN

o

1 W

as t

he o

rgan

izat

ion

a p

artn

er in

a p

artn

ersh

ip, o

r a

mem

ber

of a

n LL

C,

whi

ch o

wne

d p

rop

erty

fina

nced

by

tax-

exem

pt

bon

ds?

..

..

..

..

2

Are

the

re a

ny le

ase

arra

ngem

ents

tha

t m

ay r

esul

t in

priv

ate

bus

ines

s us

e of

b

ond

-fin

ance

d p

rop

erty

? .

..

..

..

..

..

..

..

..

.

For

Pap

erw

ork

Red

ucti

on

Act

No

tice

, see

the

Inst

ruct

ions

fo

r Fo

rm 9

90.

Cat

. No.

501

93E

Sch

edul

e K

(Fo

rm 9

90) 2

010


Sch

edul

e K

(For

m 9

90) 2

010

Pag

e 2

Par

t III

Pri

vate

Bus

ines

s U

se (C

ontin

ued

)A

BC

DY

esN

oY

esN

oY

esN

oY

esN

o

3a

Are

the

re a

ny m

anag

emen

t or

ser

vice

con

trac

ts t

hat

may

res

ult

in p

rivat

e b

usin

ess

use

of b

ond

-fin

ance

d p

rop

erty

? .

..

..

..

..

..

b

Are

the

re a

ny r

esea

rch

agre

emen

ts t

hat

may

res

ult

in p

rivat

e b

usin

ess

use

of

bon

d-f

inan

ced

pro

per

ty?

..

..

..

..

..

..

..

..

.

c D

oes

the

orga

niza

tion

rout

inel

y en

gage

bon

d c

ouns

el o

r ot

her

outs

ide

co

unse

l to

re

view

an

y m

anag

emen

t or

se

rvic

e co

ntra

cts

or

rese

arch

ag

reem

ents

rel

atin

g to

the

fina

nced

pro

per

ty?

..

..

..

..

..

4 E

nter

the

per

cent

age

of f

inan

ced

pro

per

ty u

sed

in a

priv

ate

bus

ines

s us

e b

y en

titie

s ot

her

than

a

sect

ion

501(

c)(3

) or

gani

zatio

n or

a

stat

e or

lo

cal

gove

rnm

ent

..

..

..

..

..

..

..

..

..

..

.

%%

%%

5 En

ter

the

perc

enta

ge o

f fin

ance

d pr

oper

ty u

sed

in a

priv

ate

busi

ness

use

as

a re

sult

of u

nrel

ated

tra

de o

r bu

sine

ss a

ctiv

ity c

arrie

d on

by

your

org

aniz

atio

n,

anot

her s

ectio

n 50

1(c)

(3) o

rgan

izat

ion,

or a

sta

te o

r loc

al g

over

nmen

t .

..

%%

%%

6To

tal o

f lin

es 4

and

5

..

..

..

..

..

..

..

..

..

%%

%%

7

Has

the

org

aniz

atio

n ad

opte

d m

anag

emen

t p

ract

ices

and

pro

ced

ures

to

ensu

re t

he p

ost-

issu

ance

com

plia

nce

of it

s ta

x-ex

emp

t b

ond

liab

ilitie

s?

.

Par

t IV

Arb

itra

ge

AB

CD

Yes

No

Yes

No

Yes

No

Yes

No

1 H

as a

For

m 8

038-

T, A

rbitr

age

Reb

ate,

Yie

ld R

educ

tion

and

Pen

alty

in L

ieu

of

Arb

itrag

e R

ebat

e, b

een

filed

with

res

pec

t to

the

bon

d is

sue?

.

..

..

.

2Is

the

bon

d is

sue

a va

riab

le r

ate

issu

e?

..

..

..

..

..

..

.3a

H

as t

he o

rgan

izat

ion

or t

he g

over

nmen

tal

issu

er e

nter

ed i

nto

a q

ualif

ied

he

dge

with

res

pec

t to

the

bon

d is

sue?

..

..

..

..

..

..

.

bN

ame

of p

rovi

der

.

..

..

..

..

..

..

..

..

..

.c

Term

of h

edge

.

..

..

..

..

..

..

..

..

..

..

dW

as t

he h

edge

sup

erin

tegr

ated

? .

..

..

..

..

..

..

..

eW

as t

he h

edge

ter

min

ated

? .

..

..

..

..

..

..

..

..

4aW

ere

gros

s p

roce

eds

inve

sted

in a

GIC

? .

..

..

..

..

..

.b

Nam

e of

pro

vid

er

..

..

..

..

..

..

..

..

..

..

cTe

rm o

f GIC

.

..

..

..

..

..

..

..

..

..

..

.d

W

as t

he r

egul

ator

y sa

fe h

arb

or fo

r es

tab

lishi

ng t

he fa

ir m

arke

t va

lue

of t

he

GIC

sat

isfie

d?

..

..

..

..

..

..

..

..

..

..

.

5W

ere

any

gros

s p

roce

eds

inve

sted

bey

ond

an

avai

lab

le t

emp

orar

y p

erio

d?

. 6

Did

the

bon

d is

sue

qua

lify

for

an e

xcep

tion

to r

ebat

e?

..

..

..

..

Par

t V

Sup

ple

men

tal I

nfo

rmat

ion.

Com

ple

te t

his

par

t to

pro

vid

e ad

diti

onal

info

rmat

ion

for

resp

onse

s to

que

stio

ns o

n S

ched

ule

K (s

ee in

stru

ctio

ns).

Sch

edul

e K

(Fo

rm 9

90) 2

010


SCHEDULE L (Form 990 or 990-EZ)


Transactions With Interested Persons Complete if the organization answered

“Yes” on Form 990, Part IV, line 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.

Attach to Form 990 or Form 990-EZ. See separate instructions.

OMB No. 1545-0047

2010Open To Public Inspection


Part I Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only). Complete if the organization answered “Yes” on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1 (a) Name of disqualified person (b) Description of transaction(c) Corrected?

Yes No

(1)(2)(3)(4)(5)(6)2 Enter the amount of tax imposed on the organization managers or disqualified persons during the year

under section 4958 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $3 Enter the amount of tax, if any, on line 2, above, reimbursed by the organization . . . . . . . . $

Part II Loans to and/or From Interested Persons. Complete if the organization answered “Yes” on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose (b) Loan to or from the organization?

(c) Original principal amount

(d) Balance due (e) In default? (f) Approved by board or committee?

(g) Written agreement?

To From Yes No Yes No Yes No

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)Total . . . . . . . . . . . . . . . . . . . . . . $Part III Grants or Assistance Benefiting Interested Persons.

Complete if the organization answered “Yes” on Form 990, Part IV, line 27.

(a) Name of interested person (b) Relationship between interested person and the organization

(c) Amount and type of assistance

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Cat. No. 50056A Schedule L (Form 990 or 990-EZ) 2010


Schedule L (Form 990 or 990-EZ) 2010 Page 2 Part IV Business Transactions Involving Interested Persons.

Complete if the organization answered “Yes” on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person (b) Relationship between interested person and the

organization

(c) Amount of transaction

(d) Description of transaction (e) Sharing of organization’s

revenues?

Yes No

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)Part V Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Schedule L (Form 990 or 990-EZ) 2010


SCHEDULE M (Form 990)


Noncash Contributions Complete if the organizations answered “Yes” on Form

990, Part IV, lines 29 or 30.

Attach to Form 990.

OMB No. 1545-0047

2010Open To Public


Part I Types of Property(a)

Check if applicable

(b) Number of contributions or

items contributed

(c) Noncash contribution amounts reported on

Form 990, Part VIII, line 1g

(d) Method of determining

noncash contribution amounts

1 Art—Works of art . . . . .2 Art—Historical treasures . . .3 Art—Fractional interests . . .4 Books and publications . . .5

Clothing and household goods . . . . . . . . .

6 Cars and other vehicles . . .7 Boats and planes . . . . .8 Intellectual property . . . .9 Securities—Publicly traded . .

10 Securities—Closely held stock .11

Securities—Partnership, LLC, or trust interests . . . . .

12 Securities—Miscellaneous . .13

Qualified conservation contribution—Historic structures . . . . . . . .

14

Qualified conservation contribution—Other . . . .

15 Real estate—Residential . . .16 Real estate—Commercial . .17 Real estate—Other . . . . .18 Collectibles . . . . . . .19 Food inventory . . . . . .20 Drugs and medical supplies . .21 Taxidermy . . . . . . .22 Historical artifacts . . . . .23 Scientific specimens . . . .24 Archeological artifacts . . .25 Other ( )

26 Other ( )

27 Other ( )

28 Other ( )29 Number of Forms 8283 received by the organization during the tax year for contributions for

which the organization completed Form 8283, Part IV, Donee Acknowledgement . . . . . 29 Yes No

30 a

During the year, did the organization receive by contribution any property reported in Part I, lines 1–28 that it must hold for at least three years from the date of the initial contribution, and which is not required to be used for exempt purposes for the entire holding period? . . . . . . . . . . . . . . . . . 30a

b If “Yes,” describe the arrangement in Part II.31 Does the organization have a gift acceptance policy that requires the review of any non-standard

contributions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3132 a Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32ab If “Yes,” describe in Part II.

33 If the organization did not report an amount in column (c) for a type of property for which column (a) is checked, describe in Part II.

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 51227J Schedule M (Form 990) (2010)


Schedule M (Form 990) (2010) Page 2Part II Supplemental Information. Complete this part to provide the information required by Part I, lines 30b, 32b,

and 33. Also complete this part for any additional information.

Schedule M (Form 990) (2010)


SCH

EDU

LE N

(F

orm

990

or 9

90-E

Z)

Dep

artm

ent o

f the

Tre

asur

y

Inte

rnal

Rev

enue

Ser

vice

Liqu

idat

ion,

Ter

min

atio

n, D

isso

luti

on, or

Sig

nific

ant

Dis

posi

tion

of A

sset

s C

om

ple

te if

the

org

aniz

atio

n an

swer

ed "

Yes

" to

Fo

rm 9

90, P

art

IV, l

ines

31

or

32; o

r Fo

rm 9

90-E

Z, l

ine

36.

Att

ach

cert

ified

co

pie

s o

f an

y ar

ticl

es o

f d

isso

luti

on,

res

olu

tio

ns, o

r p

lans

.

Att

ach

to F

orm

990

or

990-

EZ

.

OM

B N

o. 1

545-

0047

2010

Op

en t

o P

ublic

In

spec

tio

nN

ame

of t

he o

rgan

izat

ion

Em

plo

yer

iden

tific

atio

n nu

mb

er

Par

t I

Liq

uid

atio

n, T

erm

inat

ion,

or

Dis

solu

tio

n. C

omp

lete

thi

s p

art

if th

e or

gani

zatio

n an

swer

ed “

Yes

” to

For

m 9

90, P

art

IV, l

ine

31, o

r Fo

rm 9

90-E

Z, l

ine

36.

Par

t I c

an b

e d

uplic

ated

if a

dd

ition

al s

pac

e is

nee

ded

.1

(a) D

escr

iptio

n of

ass

et(s

) d

istr

ibut

ed o

r tr

ansa

ctio

n ex

pen

ses

pai

d

(b) D

ate

of

dis

trib

utio

n(c

) Fai

r m

arke

t va

lue

of

asse

t(s) d

istr

ibut

ed o

r am

ount

of t

rans

actio

n ex

pen

ses

(d) M

etho

d o

f d

eter

min

ing

FMV

for

asse

t(s) d

istr

ibut

ed o

r tr

ansa

ctio

n ex

pen

ses

(e) E

IN o

f rec

ipie

nt(f

) Nam

e an

d a

dd

ress

of r

ecip

ient

(g) I

RC

sec

tion

of

reci

pie

nt(s

) (if

tax-

exem

pt)

or t

ype

of e

ntity Yes

No

2D

id o

r w

ill a

ny o

ffic

er, d

irect

or, t

rust

ee, o

r ke

y em

plo

yee

of t

he o

rgan

izat

ion:

aB

ecom

e a

dire

ctor

or

trus

tee

of a

suc

cess

or o

r tr

ansf

eree

org

aniz

atio

n?

..

..

..

..

..

..

..

..

..

..

..

..

..

.2a

bB

ecom

e an

em

plo

yee

of, o

r in

dep

end

ent

cont

ract

or fo

r, a

suc

cess

or o

r tr

ansf

eree

org

aniz

atio

n?

..

..

..

..

..

..

..

..

..

.2b

cB

ecom

e a

dire

ct o

r in

dire

ct o

wne

r of

a s

ucce

ssor

or

tran

sfer

ee o

rgan

izat

ion?

.

..

..

..

..

..

..

..

..

..

..

..

..

2cd

Rec

eive

, or

bec

ome

entit

led

to,

com

pen

satio

n or

oth

er s

imila

r p

aym

ents

as

a re

sult

of t

he o

rgan

izat

ion’

s liq

uid

atio

n, t

erm

inat

ion,

or

dis

solu

tion?

.

..

2de

If th

e or

gani

zatio

n an

swer

ed “

Yes

” to

any

of t

he q

uest

ions

in t

his

line,

pro

vid

e th

e na

me

of t

he p

erso

n in

volv

ed a

nd e

xpla

in in

Par

t III

. Fo

r P

aper

wo

rk R

educ

tio

n A

ct N

oti

ce, s

ee t

he In

stru

ctio

ns f

or

Form

990

or

Form

990

-EZ

.C

at. N

o. 5

0087

ZS

ched

ule

N (F

orm

990

or

990-

EZ

) (20

10)


Sch

edul

e N

(For

m 9

90 o

r 99

0-E

Z) (

2010

)P

age

2P

art

ILi

qui

dat

ion,

Ter

min

atio

n, o

r D

isso

luti

on

(con

tinue

d)

No

te.

If th

e or

gani

zatio

n d

istr

ibut

ed a

ll of

its

asse

ts d

urin

g th

e ta

x ye

ar, t

hen

Form

990

, Par

t X

, col

umn

(B) s

houl

d e

qua

l -0-

.Y

esN

o

3D

id t

he o

rgan

izat

ion

dis

trib

ute

its a

sset

s in

acc

ord

ance

with

its

gove

rnin

g in

stru

men

t(s)?

If “

No,

” d

escr

ibe

in P

art

III .

..

..

..

..

..

..

34a

Is t

he o

rgan

izat

ion

req

uire

d t

o no

tify

the

atto

rney

gen

eral

or

othe

r ap

pro

pria

te s

tate

off

icia

l of i

ts in

tent

to

dis

solv

e, li

qui

dat

e, o

r te

rmin

ate?

.

..

..

4ab

If “Y

es,”

did

the

org

aniz

atio

n p

rovi

de

such

not

ice?

.

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.4b

5D

id t

he o

rgan

izat

ion

dis

char

ge o

r p

ay a

ll lia

bili

ties

in a

ccor

dan

ce w

ith s

tate

law

s?

..

..

..

..

..

..

..

..

..

..

..

..

56a

Did

the

org

aniz

atio

n ha

ve a

ny t

ax-e

xem

pt

bon

ds

outs

tand

ing

dur

ing

the

year

? .

..

..

..

..

..

..

..

..

..

..

..

..

6ab

Did

the

org

aniz

atio

n d

isch

arge

or

def

ease

tax

-exe

mp

t b

ond

liab

ilitie

s in

acc

ord

ance

with

the

Inte

rnal

Rev

enue

Cod

e an

d s

tate

law

s? .

..

..

..

6bc

If “Y

es,”

des

crib

e in

Par

t III

how

the

org

aniz

atio

n d

efea

sed

or

othe

rwis

e se

ttle

d t

hese

liab

ilitie

s. If

“N

o,”

exp

lain

in P

art

III.

Par

t II

Sal

e, E

xcha

nge,

Dis

po

siti

on,

or

Oth

er T

rans

fer

of

Mo

re T

han

25%

of

the

Org

aniz

atio

n’s

Ass

ets.

Com

ple

te t

his

par

t if

the

orga

niza

tion

answ

ered

“Y

es”

to F

orm

990

, Par

t IV

, lin

e 32

, or

Form

990

-EZ

, lin

e 36

. Par

t II

can

be

dup

licat

ed if

ad

diti

onal

sp

ace

is n

eed

ed.

1(a

) Des

crip

tion

of a

sset

(s)

dis

trib

uted

or

tran

sact

ion

exp

ense

s p

aid

(b) D

ate

of

dis

trib

utio

n(c

) Fai

r m

arke

t va

lue

of

asse

t(s) d

istr

ibut

ed o

r am

ount

of t

rans

actio

n ex

pen

ses

(d) M

etho

d o

f d

eter

min

ing

FMV

for

asse

t(s) d

istr

ibut

ed o

r tr

ansa

ctio

n ex

pen

ses

(e) E

IN o

f rec

ipie

nt(f

) Nam

e an

d a

dd

ress

of r

ecip

ient

(g) I

RC

sec

tion

of

reci

pie

nt(s

) (if

tax-

exem

pt)

or t

ype

of e

ntity Yes

No

2D

id o

r w

ill a

ny o

ffic

er, d

irect

or, t

rust

ee, o

r ke

y em

plo

yee

of t

he o

rgan

izat

ion:

aB

ecom

e a

dire

ctor

or

trus

tee

of a

suc

cess

or o

r tr

ansf

eree

org

aniz

atio

n?

..

..

..

..

..

..

..

..

..

..

..

..

..

.2a

bB

ecom

e an

em

plo

yee

of, o

r in

dep

end

ent

cont

ract

or fo

r, a

suc

cess

or o

r tr

ansf

eree

org

aniz

atio

n?

..

..

..

..

..

..

..

..

..

.2b

cB

ecom

e a

dire

ct o

r in

dire

ct o

wne

r of

a s

ucce

ssor

or

tran

sfer

ee o

rgan

izat

ion?

.

..

..

..

..

..

..

..

..

..

..

..

..

2cd

Rec

eive

, or

bec

ome

entit

led

to,

com

pen

satio

n or

oth

er s

imila

r p

aym

ents

as

a re

sult

of t

he o

rgan

izat

ion’

s si

gnifi

cant

dis

pos

ition

of a

sset

s?

..

..

.2d

eIf

the

orga

niza

tion

answ

ered

“Y

es”

to a

ny o

f the

que

stio

ns in

thi

s lin

e, p

rovi

de

the

nam

e of

the

per

son

invo

lved

and

exp

lain

in P

art

III.

Sch

edul

e N

(Fo

rm 9

90 o

r 99

0-E

Z) (

2010

)

✔✔

✔

✔


Schedule N (Form 990 or 990-EZ) (2010) Page 3Part III Supplemental Information. Complete to provide the information required by Part I, lines 2e and 6c, and Part

II, line 2e. Also complete this part to provide any additional information.

Schedule N (Form 990 or 990-EZ) (2010)


SCHEDULE O (Form 990 or 990-EZ)


Supplemental Information to Form 990 or 990-EZComplete to provide information for responses to specific questions on

Form 990 or 990-EZ or to provide any additional information.

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047



For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Cat. No. 51056K Schedule O (Form 990 or 990-EZ) (2010)


Schedule O (Form 990 or 990-EZ) (2010) Page 2 Name of the organization Employer identification number

Schedule O (Form 990 or 990-EZ) (2010)


SC

HE

DU

LE R

(F

orm

990

)

Dep

artm

ent o

f the

Tre

asur

y

Inte

rnal

Rev

enue

Ser

vice

Rel

ated

Org

aniz

atio

ns a

nd U

nrel

ated

Par

tner

ship

s

Co

mp

lete

if t

he o

rgan

izat

ion

answ

ered

"Y

es"

to F

orm

990

, Par

t IV

, lin

e 33

, 34,

35,

36,

or

37.

Att

ach

to F

orm

990

.

S

ee s

epar

ate

inst

ruct

ions

.

OM

B N

o. 1

545-

0047

2010

Op

en t

o P

ublic

In

spec

tio

nN

ame

of t

he o

rgan

izat

ion

Em

plo

yer

iden

tific

atio

n nu

mb

er

Par

t I

Iden

tific

atio

n o

f D

isre

gar

ded

Ent

itie

s (C

omp

lete

if t

he o

rgan

izat

ion

answ

ered

“Y

es”

to F

orm

990

, Par

t IV

, lin

e 33

.)

(a)

Nam

e, a

dd

ress

, and

EIN

of d

isre

gard

ed e

ntity

(b)

Prim

ary

activ

ity(c

) Le

gal d

omic

ile (s

tate

or

fore

ign

coun

try)

(d)

Tota

l inc

ome

(e)

End

-of-

year

ass

ets

(f)

Dire

ct c

ontr

ollin

g

entit

y

(1)

(2)

(3)

(4)

(5)

(6)

Par

t II

Iden

tific

atio

n o

f R

elat

ed T

ax-E

xem

pt

Org

aniz

atio

ns (C

omp

lete

if t

he o

rgan

izat

ion

answ

ered

“Y

es”

to F

orm

990

, Par

t IV

, lin

e 34

bec

ause

it h

ad

one

or m

ore

rela

ted

tax

-exe

mp

t or

gani

zatio

ns d

urin

g th

e ta

x ye

ar.)

(a)

Nam

e, a

dd

ress

, and

EIN

of r

elat

ed o

rgan

izat

ion

(b)

Prim

ary

activ

ity(c

) Le

gal d

omic

ile (s

tate

or

fore

ign

coun

try)

(d)

Exe

mp

t C

ode

sect

ion

(e)

Pub

lic c

harit

y st

atus

(if

sec

tion

501(

c)(3

))

(f)

Dire

ct c

ontr

ollin

g

entit

y

(g)

Sec

tion

512(

b)(1

3)

cont

rolle

d en

tity?

Yes

No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

For

Pap

erw

ork

Red

ucti

on

Act

No

tice

, see

the

Inst

ruct

ions

fo

r Fo

rm 9

90.

Cat

. No.

501

35Y

Sch

edul

e R

(Fo

rm 9

90) 2

010


Sch

edul

e R

(For

m 9

90) 2

010

Pag

e 2

Par

t III

Iden

tific

atio

n o

f R

elat

ed O

rgan

izat

ions

Tax

able

as

a P

artn

ersh

ip (C

omp

lete

if t

he o

rgan

izat

ion

answ

ered

“Y

es”

to F

orm

990

, Par

t IV

, lin

e 34

b

ecau

se it

had

one

or

mor

e re

late

d o

rgan

izat

ions

tre

ated

as

a p

artn

ersh

ip d

urin

g th

e ta

x ye

ar.)

(a)

Nam

e, a

dd

ress

, and

E

IN

of

rela

ted

org

aniz

atio

n

(b)

Prim

ary

activ

ity(c

) Le

gal

dom

icile

(s

tate

or

fore

ign

coun

try)

(d)

Dire

ct c

ontr

ollin

g en

tity

(e)

Pre

dom

inan

t in

com

e (r

elat

ed,

unre

late

d,

excl

uded

from

ta

x un

der

se

ctio

ns 5

12-5

14)

(f)

Sha

re o

f tot

al in

com

e(g

) S

hare

of e

nd-o

f-ye

ar

asse

ts

(h)

Disp

ropo

rtion

ate

alloc

atio

ns?

(i)

Cod

e V

—U

BI

amou

nt in

box

20

of

Sch

edul

e K

-1

(For

m 1

065)

(j)

Gen

eral

or

man

agin

g p

artn

er?

(k)

Per

cent

age

owne

rshi

p

Y

esN

o

Y

esN

o

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Par

t IV

Iden

tific

atio

n o

f R

elat

ed O

rgan

izat

ions

Tax

able

as

a C

orp

ora

tio

n o

r T

rust

(Com

ple

te if

the

org

aniz

atio

n an

swer

ed “

Yes

” to

For

m 9

90, P

art

IV,

line

34 b

ecau

se it

had

one

or

mor

e re

late

d o

rgan

izat

ions

tre

ated

as

a co

rpor

atio

n or

tru

st d

urin

g th

e ta

x ye

ar.)

(a)

Nam

e, a

dd

ress

, and

EIN

of r

elat

ed o

rgan

izat

ion

(b)

Prim

ary

activ

ity(c

) Le

gal d

omic

ile

(sta

te o

r fo

reig

n co

untr

y)

(d)

Dire

ct c

ontr

ollin

g en

tity

(e)

Typ

e of

ent

ity

(C c

orp

, S c

orp

, or

tru

st)

(f)

Sha

re o

f tot

al in

com

e(g

) S

hare

of

end

-of-

year

ass

ets

(h)

Per

cent

age

owne

rshi

p

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Sch

edul

e R

(Fo

rm 9

90) 2

010


Sch

edul

e R

(For

m 9

90) 2

010

Pag

e 3

Par

t V

Tra

nsac

tio

ns W

ith

Rel

ated

Org

aniz

atio

ns (C

omp

lete

if t

he o

rgan

izat

ion

answ

ered

“Y

es”

to F

orm

990

, Par

t IV

, lin

e 34

, 35,

35a

, or

36.)

No

te. C

omp

lete

line

1 if

any

ent

ity is

list

ed in

Par

ts II

, III,

or

IV o

f thi

s sc

hed

ule.

Yes

No

1D

urin

g th

e ta

x ye

ar, d

id t

he o

rgan

izat

ion

enga

ge in

any

of t

he fo

llow

ing

tran

sact

ions

with

one

or

mor

e re

late

d o

rgan

izat

ions

list

ed in

Par

ts II

–IV

?a

Rec

eip

t of

(i) i

nter

est

(ii) a

nnui

ties

(iii)

roya

lties

or

(iv) r

ent

from

a c

ontr

olle

d e

ntity

.

..

..

..

..

..

..

..

..

..

..

..

.1a

bG

ift, g

rant

, or

cap

ital c

ontr

ibut

ion

to o

ther

org

aniz

atio

n(s)

.

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.1b

cG

ift, g

rant

, or

cap

ital c

ontr

ibut

ion

from

oth

er o

rgan

izat

ion(

s)

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.1c

dLo

ans

or lo

an g

uara

ntee

s to

or

for

othe

r or

gani

zatio

n(s)

.

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.1d

eLo

ans

or lo

an g

uara

ntee

s b

y ot

her

orga

niza

tion(

s)

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

1e

fS

ale

of a

sset

s to

oth

er o

rgan

izat

ion(

s)

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

1fg

Pur

chas

e of

ass

ets

from

oth

er o

rgan

izat

ion(

s) .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.1g

hE

xcha

nge

of a

sset

s .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.1h

iLe

ase

of fa

cilit

ies,

eq

uip

men

t, o

r ot

her

asse

ts t

o ot

her

orga

niza

tion(

s)

..

..

..

..

..

..

..

..

..

..

..

..

..

..

1i

jLe

ase

of fa

cilit

ies,

eq

uip

men

t, o

r ot

her

asse

ts fr

om o

ther

org

aniz

atio

n(s)

.

..

..

..

..

..

..

..

..

..

..

..

..

..

1jk

Per

form

ance

of s

ervi

ces

or m

emb

ersh

ip o

r fu

ndra

isin

g so

licita

tions

for

othe

r or

gani

zatio

n(s)

.

..

..

..

..

..

..

..

..

..

.1k

lP

erfo

rman

ce o

f ser

vice

s or

mem

ber

ship

or

fund

rais

ing

solic

itatio

ns b

y ot

her

orga

niza

tion(

s)

..

..

..

..

..

..

..

..

..

..

1lm

Sha

ring

of fa

cilit

ies,

eq

uip

men

t, m

ailin

g lis

ts, o

r ot

her

asse

ts

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.1m

nS

harin

g of

pai

d e

mp

loye

es

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

1n

oR

eim

bur

sem

ent

pai

d t

o ot

her

orga

niza

tion

for

exp

ense

s .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.1o

pR

eim

bur

sem

ent

pai

d b

y ot

her

orga

niza

tion

for

exp

ense

s .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.1p

qO

ther

tra

nsfe

r of

cas

h or

pro

per

ty t

o ot

her

orga

niza

tion(

s)

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

1qr

Oth

er t

rans

fer

of c

ash

or p

rop

erty

from

oth

er o

rgan

izat

ion(

s)

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.1r

2If

the

answ

er t

o an

y of

the

ab

ove

is “

Yes

,” s

ee t

he in

stru

ctio

ns fo

r in

form

atio

n on

who

mus

t co

mp

lete

thi

s lin

e, in

clud

ing

cove

red

rel

atio

nshi

ps

and

tra

nsac

tion

thre

shol

ds.

(a)

Nam

e of

oth

er o

rgan

izat

ion

(b)

Tran

sact

ion

typ

e (a

–r)

(c)

Am

ount

invo

lved

(d)

Met

hod

of d

eter

min

ing

amou

nt in

volv

ed

(1)

(2)

(3)

(4)

(5)

(6)

Sch

edul

e R

(Fo

rm 9

90) 2

010

✔ ✔ ✔✔ ✔✔✔✔✔ ✔ ✔✔


Sch

edul

e R

(For

m 9

90) 2

010

Pag

e 4

Par

t V

IU

nrel

ated

Org

aniz

atio

ns T

axab

le a

s a

Par

tner

ship

(Com

ple

te if

the

org

aniz

atio

n an

swer

ed “

Yes

” to

For

m 9

90, P

art

IV, l

ine

37.)

Pro

vid

e th

e fo

llow

ing

info

rmat

ion

for

each

ent

ity t

axed

as

a p

artn

ersh

ip t

hrou

gh w

hich

the

org

aniz

atio

n co

nduc

ted

mor

e th

an fi

ve p

erce

nt o

f its

act

iviti

es (m

easu

red

by

tota

l ass

ets

or g

ross

rev

enue

) tha

t w

as n

ot a

rel

ated

org

aniz

atio

n. S

ee in

stru

ctio

ns r

egar

din

g ex

clus

ion

for

cert

ain

inve

stm

ent

par

tner

ship

s.(a

) N

ame,

ad

dre

ss, a

nd E

IN o

f ent

ity(b

) P

rimar

y ac

tivity

(c)

Lega

l dom

icile

(s

tate

or

fore

ign

coun

try)

(d)

Are

all p

artn

ers

sect

ion

501(

c)(3

) or

gani

zatio

ns?

(e)

Sha

re o

f en

d-o

f-ye

ar

asse

ts

(f)

Disp

ropo

rtion

ate

allo

catio

ns?

(g)

Cod

e V

—U

BI

amou

nt in

box

20

of S

ched

ule

K-1

(F

orm

106

5)

(h)

Gen

eral

or

man

agin

g p

artn

er?

Yes

No

Yes

No

Yes

No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

Sch

edul

e R

(Fo

rm 9

90) 2

010


Schedule R (Form 990) 2010 Page 5Part VII Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Schedule R (Form 990) 2010


Form 990-EZ


Short Form Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facilities, and certain controlling organizations as defined in section 512(b)(13) must file Form 990 (see instructions).

All other organizations with gross receipts less than $200,000 and total assets less than $500,000 at the end of the year may use this form.

The organization may have to use a copy of this return to satisfy state reporting requirements.

OMB No. 1545-1150

2010Open to Public

Inspection

A For the 2010 calendar year, or tax year beginning , 2010, and ending , 20 B Check if applicable:

Address change

Name change

Initial return

Terminated

Amended return

Application pending

C Name of organization

Number and street (or P.O. box, if mail is not delivered to street address) Room/suite

City or town, state or country, and ZIP + 4


E Telephone number

F Group Exemption Number

G Accounting Method: Cash Accrual Other (specify) H Check if the organization is not required to attach Schedule B (Form 990, 990-EZ, or 990-PF).

I Website: J Tax-exempt status (check only one) — 501(c)(3) 501(c) ( ) (insert no.) 4947(a)(1) or 527

K Check if the organization is not a section 509(a)(3) supporting organization and its gross receipts are normally not more than $50,000. A Form 990-EZ or Form 990 return is not required though Form 990-N (e-postcard) may be required (see instructions). But if the organization chooses to file a return, be sure to file a complete return.

L Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II,

line 25, column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ . . . . . . . . . . . $ Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I.)

Check if the organization used Schedule O to respond to any question in this Part I . . . . . . . . . .

Rev

enue

1 Contributions, gifts, grants, and similar amounts received . . . . . . . . . . . . . 1 2 Program service revenue including government fees and contracts . . . . . . . . . 2 3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . 3 4 Investment income . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 a Gross amount from sale of assets other than inventory . . . . 5a

b Less: cost or other basis and sales expenses . . . . . . . . 5b c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) . . . . 5c

6 Gaming and fundraising events a Gross income from gaming (attach Schedule G if greater than

$15,000) . . . . . . . . . . . . . . . . . . . . 6a b Gross income from fundraising events (not including $ of contributions

from fundraising events reported on line 1) (attach Schedule G if thesum of such gross income and contributions exceeds $15,000) . . 6b

c Less: direct expenses from gaming and fundraising events . . . 6c d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract

line 6c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6d7 a Gross sales of inventory, less returns and allowances . . . . . 7a

b Less: cost of goods sold . . . . . . . . . . . . . . 7b c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) . . . . . . . 7c

8 Other revenue (describe in Schedule O) . . . . . . . . . . . . . . . . . . . 8 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 . . . . . . . . . . . . . 9

Exp

ense

s

10 Grants and similar amounts paid (list in Schedule O) . . . . . . . . . . . . . . 10 11 Benefits paid to or for members . . . . . . . . . . . . . . . . . . . . . 11 12 Salaries, other compensation, and employee benefits . . . . . . . . . . . . . . 12 13 Professional fees and other payments to independent contractors . . . . . . . . . . 13 14 Occupancy, rent, utilities, and maintenance . . . . . . . . . . . . . . . . . 14 15 Printing, publications, postage, and shipping . . . . . . . . . . . . . . . . . 15 16 Other expenses (describe in Schedule O) . . . . . . . . . . . . . . . . . . 16 17 Total expenses. Add lines 10 through 16 . . . . . . . . . . . . . . . . . 17

Net

Ass

ets 18 Excess or (deficit) for the year (Subtract line 17 from line 9) . . . . . . . . . . . . 18

19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end-of-year figure reported on prior year’s return) . . . . . . . . . . . . . . . 19

20 Other changes in net assets or fund balances (explain in Schedule O) . . . . . . . . . 20 21 Net assets or fund balances at end of year. Combine lines 18 through 20 . . . . . . 21

For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 10642I Form 990-EZ (2010)

✔✔

✔✔


Form 990-EZ (2010) Page 2 Part II Balance Sheets. (see the instructions for Part II.)

Check if the organization used Schedule O to respond to any question in this Part II . . . . . . . . . .(A) Beginning of year (B) End of year

22 Cash, savings, and investments . . . . . . . . . . . . . . . . . 22 23 Land and buildings . . . . . . . . . . . . . . . . . . . . . . 23 24 Other assets (describe in Schedule O) . . . . . . . . . . . . . . . 24 25 Total assets . . . . . . . . . . . . . . . . . . . . . . . . 25 26 Total liabilities (describe in Schedule O) . . . . . . . . . . . . . . 26 27 Net assets or fund balances (line 27 of column (B) must agree with line 21) . . 27 Part III Statement of Program Service Accomplishments (see the instructions for Part III.)

Check if the organization used Schedule O to respond to any question in this Part III . . What is the organization’s primary exempt purpose? Describe what was achieved in carrying out the organization’s exempt purposes. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.

Expenses (Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional for others.)

28

(Grants $ ) If this amount includes foreign grants, check here . . . . 28a 29

(Grants $ ) If this amount includes foreign grants, check here . . . . 29a 30

(Grants $ ) If this amount includes foreign grants, check here . . . . 30a 31 Other program services (describe in Schedule O) . . . . . . . . . . . . . . . . . .

(Grants $ ) If this amount includes foreign grants, check here . . . . 31a 32 Total program service expenses (add lines 28a through 31a) . . . . . . . . . . . . . 32 Part IV List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated. (see the instructions for Part IV.)

Check if the organization used Schedule O to respond to any question in this Part IV . . . . . . . . .

(a) Name and address (b) Title and average

hours per week devoted to position

(c) Compensation (If not paid, enter -0-.)

(d) Contributions to employee benefit plans & deferred compensation

(e) Expense account and

other allowances

Form 990-EZ (2010)


Form 990-EZ (2010) Page 3 Part V Other Information (Note the statement requirements in the instructions for Part V.)

Check if the organization used Schedule O to respond to any question in this Part V . . . . . . . . . .Yes No

33 Did the organization engage in any activity not previously reported to the IRS? If “Yes,” provide a detailed description of each activity in Schedule O . . . . . . . . . . . . . . . . . . . . . . 33

34 Were any significant changes made to the organizing or governing documents? If “Yes,” attach a conformed copy of the amended documents if they reflect a change to the organization's name. Otherwise, explain thechange on Schedule O (see instructions) . . . . . . . . . . . . . . . . . . . . . . 34

35 If the organization had income from business activities, such as those reported on lines 2, 6a, and 7a (among others), but not reported on Form 990-T, explain in Schedule O why the organization did not report the income on Form 990-T.

a Did the organization have unrelated business gross income of $1,000 or more or was it a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements? 35a

b If “Yes,” has it filed a tax return on Form 990-T for this year (see instructions)? . . . . . . . . . . 35b 36 Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets

during the year? If “Yes,” complete applicable parts of Schedule N . . . . . . . . . . . . . 36 37 a Enter amount of political expenditures, direct or indirect, as described in the instructions. 37a

b Did the organization file Form 1120-POL for this year? . . . . . . . . . . . . . . . . . . 37b 38a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were

any such loans made in a prior year and still outstanding at the end of the tax year covered by this return? . 38a b If “Yes,” complete Schedule L, Part II and enter the total amount involved . . . . 38b

39 Section 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on line 9 . . . . . . . . . . 39a b Gross receipts, included on line 9, for public use of club facilities . . . . . . . 39b

40 a Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under: section 4911 ; section 4912 ; section 4955

b Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I . . . . . . . 40b

c Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 . . . . . . . . . . . . . . . . . . . . . . .

d Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization . . . . . . . . . . . . . . . . .

e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If “Yes,” complete Form 8886-T. . . . . . . . . . . . . . . . . . . . . . 40e

41 List the states with which a copy of this return is filed. 42a The organization's books are in care of Telephone no.

Located at ZIP + 4 b At any time during the calendar year, did the organization have an interest in or a signature or other authority

over a financial account in a foreign country (such as a bank account, securities account, or other financial account)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes No 42b

If “Yes,” enter the name of the foreign country: See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.

c At any time during the calendar year, did the organization maintain an office outside of the U.S.? . . . . 42c If “Yes,” enter the name of the foreign country:

43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041—Check here . . . . . . and enter the amount of tax-exempt interest received or accrued during the tax year . . . . . 43

Yes No 44 a Did the organization maintain any donor advised funds during the year? If “Yes,” Form 990 must be

completed instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . 44a b Did the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must be

completed instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . 44b c Did the organization receive any payments for indoor tanning services during the year? . . . . . . . 44c d If "Yes" to line 44c, has the organization filed a Form 720 to report these payments? If "No," provide an

explanation in Schedule O . . . . . . . . . . . . . . . . . . . . . . . . . . . 44d

Form 990-EZ (2010)


Form 990-EZ (2010) Page 4 Yes No

45 Is any related organization a controlled entity of the organization within the meaning of section 512(b)(13)? 45 a Did the organization receive any payment from or engage in any transaction with a controlled entity within the

meaning of section 512(b)(13)? If “Yes,” Form 990 and Schedule R may need to be completed instead ofForm 990-EZ (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 45a

46 Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in oppositionto candidates for public office? If “Yes,” complete Schedule C, Part I . . . . . . . . . . . . . 46

Part VI Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. All section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47–49b and 52, and complete the tables for lines 50 and 51.Check if the organization used Schedule O to respond to any question in this Part VI . . . . . . . . .

Yes No47 Did the organization engage in lobbying activities? If “Yes,” complete Schedule C, Part II . . . . . . 47 48 Is the organization a school as described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E . . . . 48 49 a Did the organization make any transfers to an exempt non-charitable related organization? . . . . . . 49a

b If “Yes,” was the related organization a section 527 organization? . . . . . . . . . . . . . . 49b 50 Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key

employees) who each received more than $100,000 of compensation from the organization. If there is none, enter “None.”

(a) Name and address of each employee paid more than $100,000

(b) Title and average hours per week

devoted to position

(c) Compensation (d) Contributions to employee benefit plans & deferred compensation

(e) Expense account and

other allowances

f Total number of other employees paid over $100,000 . . . .

51 Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter “None.”

(a) Name and address of each independent contractor paid more than $100,000 (b) Type of service (c) Compensation

d Total number of other independent contractors each receiving over $100,000 . .

52 Did the organization complete Schedule A? Note: All section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach a completed Schedule A . . . . . . . . . . . . . Yes No

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign Here





PTIN



May the IRS discuss this return with the preparer shown above? See instructions . . . . . . . . . . Yes No

Form 990-EZ (2010)


Form 990-PFDepartment of the Treasury Internal Revenue Service

Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust

Treated as a Private FoundationNote. The foundation may be able to use a copy of this return to satisfy state reporting requirements.

OMB No. 1545-0052

2010For calendar year 2010, or tax year beginning , 2010, and ending , 20

G Check all that apply: Initial return Initial return of a former public charity Final returnAmended return Address change Name change

Name of foundation

Number and street (or P.O. box number if mail is not delivered to street address) Room/suite


A Employer identification number

B Telephone number (see page 10 of the instructions)

C If exemption application is pending, check here

D 1. Foreign organizations, check here . . .2. Foreign organizations meeting the 85% test,

check here and attach computation . .

E If private foundation status was terminated under section 507(b)(1)(A), check here . . . .

F If the foundation is in a 60-month termination under section 507(b)(1)(B), check here . .

H Check type of organization: Section 501(c)(3) exempt private foundationSection 4947(a)(1) nonexempt charitable trust Other taxable private foundation

I Fair market value of all assets at end of year (from Part II, col. (c), line 16) $

J Accounting method: Cash AccrualOther (specify)

(Part I, column (d) must be on cash basis.)

Part I

Rev

enue

Op

erat

ing

and

Ad

min

istr

ativ

e E

xpen

ses

Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see page 11 of the instructions).)

(a) Revenue and expenses per

books

(b) Net investment income

(c) Adjusted net income

(d) Disbursements for charitable

purposes (cash basis only)

1 Contributions, gifts, grants, etc., received (attach schedule)2 Check if the foundation is not required to attach Sch. B3 Interest on savings and temporary cash investments4 Dividends and interest from securities . . . .5a Gross rents . . . . . . . . . . . . .b Net rental income or (loss)

6a Net gain or (loss) from sale of assets not on line 10b Gross sales price for all assets on line 6a

7 Capital gain net income (from Part IV, line 2) . .8 Net short-term capital gain . . . . . . . .9 Income modifications . . . . . . . . .

10a Gross sales less returns and allowancesb Less: Cost of goods sold . . .c Gross profit or (loss) (attach schedule) . . . .

11 Other income (attach schedule) . . . . . .12 Total. Add lines 1 through 11 . . . . . . .13 Compensation of officers, directors, trustees, etc.14 Other employee salaries and wages . . . . .15 Pension plans, employee benefits . . . . .16a Legal fees (attach schedule) . . . . . . .

b Accounting fees (attach schedule) . . . . .c Other professional fees (attach schedule) . . .

17 Interest . . . . . . . . . . . . . .18 Taxes (attach schedule) (see page 14 of the instructions)19 Depreciation (attach schedule) and depletion . .20 Occupancy . . . . . . . . . . . . .21 Travel, conferences, and meetings . . . . .22 Printing and publications . . . . . . . .23 Other expenses (attach schedule) . . . . .24 Total operating and administrative expenses.

Add lines 13 through 23 . . . . . . . . .

25 Contributions, gifts, grants paid . . . . . .26 Total expenses and disbursements. Add lines 24 and 2527 Subtract line 26 from line 12:

a Excess of revenue over expenses and disbursementsb Net investment income (if negative, enter -0-) .c Adjusted net income (if negative, enter -0-) . .

For Paperwork Reduction Act Notice, see page 30 of the instructions. Cat. No. 11289X Form 990-PF (2010)


Form 990-PF (2010) Page 2

Part II Balance SheetsAttached schedules and amounts in the description column should be for end-of-year amounts only. (See instructions.)

Beginning of year

(a) Book Value

End of year

(b) Book Value (c) Fair Market Value

Ass

ets

Liab

iliti

esN

et A

sset

s o

r Fu

nd B

alan

ces

1 Cash—non-interest-bearing . . . . . . . . . . .2 Savings and temporary cash investments . . . . . . .3 Accounts receivable

Less: allowance for doubtful accounts 4 Pledges receivable

Less: allowance for doubtful accounts 5 Grants receivable . . . . . . . . . . . . . . .6

Receivables due from officers, directors, trustees, and other disqualified persons (attach schedule) (see page 15 of the instructions) . . . . . . . . . . . . . . . . .

7 Other notes and loans receivable (attach schedule) Less: allowance for doubtful accounts

8 Inventories for sale or use . . . . . . . . . . . .9 Prepaid expenses and deferred charges . . . . . . .

10a Investments—U.S. and state government obligations (attach schedule)b Investments—corporate stock (attach schedule) . . . . .c Investments—corporate bonds (attach schedule) . . . .

11 Investments—land, buildings, and equipment: basis Less: accumulated depreciation (attach schedule)

12 Investments—mortgage loans . . . . . . . . . . .13 Investments—other (attach schedule) . . . . . . . .14 Land, buildings, and equipment: basis

Less: accumulated depreciation (attach schedule) 15 Other assets (describe )16 Total assets (to be completed by all filers—see the

instructions. Also, see page 1, item I) . . . . . . . .

17 Accounts payable and accrued expenses . . . . . . .18 Grants payable . . . . . . . . . . . . . . . .19 Deferred revenue . . . . . . . . . . . . . . .20 Loans from officers, directors, trustees, and other disqualified persons21 Mortgages and other notes payable (attach schedule) . . .22 Other liabilities (describe )23 Total liabilities (add lines 17 through 22) . . . . . . .

Foundations that follow SFAS 117, check here . . and complete lines 24 through 26 and lines 30 and 31.

24 Unrestricted . . . . . . . . . . . . . . . . .25 Temporarily restricted . . . . . . . . . . . . .26 Permanently restricted . . . . . . . . . . . . .

Foundations that do not follow SFAS 117, check here and complete lines 27 through 31.

27 Capital stock, trust principal, or current funds . . . . . .28 Paid-in or capital surplus, or land, bldg., and equipment fund29 Retained earnings, accumulated income, endowment, or other funds30 Total net assets or fund balances (see page 17 of the

instructions) . . . . . . . . . . . . . . . . .31 Total liabilities and net assets/fund balances (see page 17

of the instructions) . . . . . . . . . . . . . .

Part III Analysis of Changes in Net Assets or Fund Balances1 Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree with

end-of-year figure reported on prior year’s return) . . . . . . . . . . . . . . . . . 12 Enter amount from Part I, line 27a . . . . . . . . . . . . . . . . . . . . . . 23 Other increases not included in line 2 (itemize) 34 Add lines 1, 2, and 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Decreases not included in line 2 (itemize) 56 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 . . 6

Form 990-PF (2010)


Form 990-PF (2010) Page 3 Part IV Capital Gains and Losses for Tax on Investment Income

(a) List and describe the kind(s) of property sold (e.g., real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co.)

(b) How acquired P—Purchase D—Donation

(c) Date acquired (mo., day, yr.)

(d) Date sold (mo., day, yr.)

1abcde

(e) Gross sales price(f) Depreciation allowed

(or allowable)(g) Cost or other basis plus expense of sale

(h) Gain or (loss) (e) plus (f) minus (g)

abcde

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69

(i) F.M.V. as of 12/31/69(j) Adjusted basis

as of 12/31/69(k) Excess of col. (i) over col. (j), if any

(l) Gains (Col. (h) gain minus col. (k), but not less than -0-) or

Losses (from col. (h))

abcde

2 Capital gain net income or (net capital loss) { If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7 } 2

3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6): If gain, also enter in Part I, line 8, column (c) (see pages 13 and 17 of the instructions). If (loss), enter -0- in Part I, line 8 . . . . . . . . . . . . . . . . . } 3

Part V Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)

If section 4940(d)(2) applies, leave this part blank.

Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period? Yes NoIf “Yes,” the foundation does not qualify under section 4940(e). Do not complete this part.

1 Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.(a)

Base period years Calendar year (or tax year beginning in)

(b) Adjusted qualifying distributions

(c) Net value of noncharitable-use assets

(d) Distribution ratio

(col. (b) divided by col. (c))

20092008200720062005

2 Total of line 1, column (d) . . . . . . . . . . . . . . . . . . . . . . 23 Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by the

number of years the foundation has been in existence if less than 5 years . . . . . . 3

4 Enter the net value of noncharitable-use assets for 2010 from Part X, line 5 . . . . . . 4

5 Multiply line 4 by line 3 . . . . . . . . . . . . . . . . . . . . . . . 5

6 Enter 1% of net investment income (1% of Part I, line 27b) . . . . . . . . . . . 6

7 Add lines 5 and 6 . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 Enter qualifying distributions from Part XII, line 4 . . . . . . . . . . . . . . . 8If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See thePart VI instructions on page 18.

Form 990-PF (2010)


Form 990-PF (2010) Page 4 Part VI Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)

1a Exempt operating foundations described in section 4940(d)(2), check here and enter “N/A” on line 1.Date of ruling or determination letter: (attach copy of letter if necessary—see instructions)

b Domestic foundations that meet the section 4940(e) requirements in Part V, checkhere and enter 1% of Part I, line 27b . . . . . . . . . . . . . . . . .

c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% ofPart I, line 12, col. (b).

} 1

2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 23 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 45 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- . . . . 56 Credits/Payments:

a 2010 estimated tax payments and 2009 overpayment credited to 2010 6ab Exempt foreign organizations—tax withheld at source . . . . . 6bc Tax paid with application for extension of time to file (Form 8868) . 6cd Backup withholding erroneously withheld . . . . . . . . . 6d

7 Total credits and payments. Add lines 6a through 6d . . . . . . . . . . . . . . . 78 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached 89 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed . . . . . . 9

10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid . . 1011 Enter the amount of line 10 to be: Credited to 2011 estimated tax Refunded 11Part VII-A Statements Regarding Activities

1a During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in any political campaign? . . . . . . . . . . . . . . . . . . .

Yes No1a

b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of the instructions for definition)? . . . . . . . . . . . . . . . . . . . . . . . . . 1bIf the answer is “Yes” to 1a or 1b, attach a detailed description of the activities and copies of any materialspublished or distributed by the foundation in connection with the activities.

c Did the foundation file Form 1120-POL for this year? . . . . . . . . . . . . . . . . . . 1cd Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

(1) On the foundation. $ (2) On foundation managers. $e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers. $2 Has the foundation engaged in any activities that have not previously been reported to the IRS? . . . . 2

If “Yes,” attach a detailed description of the activities.3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of

incorporation, or bylaws, or other similar instruments? If “Yes,” attach a conformed copy of the changes . . . 34a Did the foundation have unrelated business gross income of $1,000 or more during the year? . . . . . 4a

b If “Yes,” has it filed a tax return on Form 990-T for this year? . . . . . . . . . . . . . . . . 4b5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? . . . . . 5

If “Yes,” attach the statement required by General Instruction T.6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:

⦁ By language in the governing instrument, or⦁ By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law remain in the governing instrument? . . . . . . . . . . . . . . . 6

7 Did the foundation have at least $5,000 in assets at any time during the year? If “Yes,” complete Part II, col. (c), and Part XV 78a Enter the states to which the foundation reports or with which it is registered (see page 19 of the

instructions) b If the answer is “Yes” to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General

(or designate) of each state as required by General Instruction G? If “No,” attach explanation . . . . . 8b9 Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or

4942(j)(5) for calendar year 2010 or the taxable year beginning in 2010 (see instructions for Part XIV on page 27)? If “Yes,” complete Part XIV . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Did any persons become substantial contributors during the tax year? If “Yes,” attach a schedule listing their names and addresses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Form 990-PF (2010)


Form 990-PF (2010) Page 5 Part VII-A Statements Regarding Activities (continued)11 At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the

meaning of section 512(b)(13)? If “Yes,” attach schedule (see page 20 of the instructions) . . . . . . 1112 Did the foundation acquire a direct or indirect interest in any applicable insurance contract before

August 17, 2008? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1213 Did the foundation comply with the public inspection requirements for its annual returns and exemption application? 13

Website address 14 The books are in care of Telephone no.

Located at ZIP+4 15 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041—Check here. . . . . . .

and enter the amount of tax-exempt interest received or accrued during the year . . . . . 1516 At any time during calendar year 2010, did the foundation have an interest in or a signature or other authority

over a bank, securities, or other financial account in a foreign country?. . . . . . . . . . . . .Yes No

16See page 20 of the instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes," enter the name of the foreign country

Part VII-B Statements Regarding Activities for Which Form 4720 May Be RequiredFile Form 4720 if any item is checked in the “Yes” column, unless an exception applies. Yes No

1a During the year did the foundation (either directly or indirectly):(1) Engage in the sale or exchange, or leasing of property with a disqualified person? . . Yes No(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a

disqualified person? . . . . . . . . . . . . . . . . . . . . . . . Yes No

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? . . Yes No

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? . . Yes No(5) Transfer any income or assets to a disqualified person (or make any of either available for

the benefit or use of a disqualified person)? . . . . . . . . . . . . . . . Yes No

(6) Agree to pay money or property to a government official? (Exception. Check “No” if thefoundation agreed to make a grant to or to employ the official for a period after termination of government service, if terminating within 90 days.) . . . . . . . . Yes No

b If any answer is “Yes” to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations section 53.4941(d)-3 or in a current notice regarding disaster assistance (see page 22 of the instructions)? . . 1bOrganizations relying on a current notice regarding disaster assistance check here . . . . . .

c Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts, that were not corrected before the first day of the tax year beginning in 2010? . . . . . . . . . . . 1c

2 Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private operating foundation defined in section 4942(j)(3) or 4942(j)(5)):

a At the end of tax year 2010, did the foundation have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginning before 2010? . . . . . . . . . . . . . . Yes No

If “Yes,” list the years 20 , 20 , 20 , 20b Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)

(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2) to all years listed, answer “No” and attach statement—see page 22 of the instructions.) . . . . . . . . 2b

c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here. 20 , 20 , 20 , 20

3a Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at any time during the year? . . . . . . . . . . . . . . . . . . . . . . Yes No

b If “Yes,” did it have excess business holdings in 2010 as a result of (1) any purchase by the foundation or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by theCommissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse ofthe 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine if thefoundation had excess business holdings in 2010.) . . . . . . . . . . . . . . . . . . . 3b

4a Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes? 4ab Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its

charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2010? 4bForm 990-PF (2010)


Form 990-PF (2010) Page 6 Part VII-B Statements Regarding Activities for Which Form 4720 May Be Required (continued)5a During the year did the foundation pay or incur any amount to:

(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? . Yes No(2) Influence the outcome of any specific public election (see section 4955); or to carry on,

directly or indirectly, any voter registration drive? . . . . . . . . . . . . . Yes No

(3) Provide a grant to an individual for travel, study, or other similar purposes? . . . . . Yes No(4) Provide a grant to an organization other than a charitable, etc., organization described in

section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see page 22 of the instructions) . . Yes No(5) Provide for any purpose other than religious, charitable, scientific, literary, or educational

purposes, or for the prevention of cruelty to children or animals? . . . . . . . . Yes Nob If any answer is “Yes” to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in

Regulations section 53.4945 or in a current notice regarding disaster assistance (see page 22 of the instructions)? 5bOrganizations relying on a current notice regarding disaster assistance check here . . . . . .

c If the answer is “Yes” to question 5a(4), does the foundation claim exemption from the tax because it maintained expenditure responsibility for the grant? . . . . . . . . . . Yes No

If “Yes,” attach the statement required by Regulations section 53.4945–5(d).6a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums

on a personal benefit contract? . . . . . . . . . . . . . . . . . . . . Yes No

b Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . 6bIf “Yes” to 6b, file Form 8870.

7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? Yes Nob If "Yes," did the foundation receive any proceeds or have any net income attributable to the transaction? . 7b

Part VIII Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors

1 List all officers, directors, trustees, foundation managers and their compensation (see page 22 of the instructions).

(a) Name and address(b) Title, and average


(c) Compensation (If not paid, enter

-0-)

(d) Contributions to employee benefit plans

and deferred compensation

(e) Expense account, other allowances

2 Compensation of five highest-paid employees (other than those included on line 1—see page 23 of the instructions). If none, enter “NONE.”

(a) Name and address of each employee paid more than $50,000(b) Title, and average


(c) Compensation

(d) Contributions to employee benefit

plans and deferred compensation

(e) Expense account, other allowances

Total number of other employees paid over $50,000 . . . . . . . . . . . . . . . . . . . .

Form 990-PF (2010)


Form 990-PF (2010) Page 7 Part VIII Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,

and Contractors (continued)3 Five highest-paid independent contractors for professional services (see page 23 of the instructions). If none, enter “NONE.”

(a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation

Total number of others receiving over $50,000 for professional services . . . . . . . . . . . . .

Part IX-A Summary of Direct Charitable Activities

List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.

Expenses

1

2

3

4

Part IX-B Summary of Program-Related Investments (see page 24 of the instructions)Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount

1

2

All other program-related investments. See page 24 of the instructions.

3

Total. Add lines 1 through 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . .Form 990-PF (2010)


Form 990-PF (2010) Page 8 Part X Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,

see page 24 of the instructions.)1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,

purposes:

a Average monthly fair market value of securities . . . . . . . . . . . . . . . . . 1ab Average of monthly cash balances . . . . . . . . . . . . . . . . . . . . . 1bc Fair market value of all other assets (see page 25 of the instructions) . . . . . . . . . . 1cd Total (add lines 1a, b, and c) . . . . . . . . . . . . . . . . . . . . . . . 1de Reduction claimed for blockage or other factors reported on lines 1a and

1c (attach detailed explanation) . . . . . . . . . . . . . . . 1e2 Acquisition indebtedness applicable to line 1 assets . . . . . . . . . . . . . . . . 23 Subtract line 2 from line 1d . . . . . . . . . . . . . . . . . . . . . . . . 34 Cash deemed held for charitable activities. Enter 1

1/2 % of line 3 (for greater amount, see page 25 ofthe instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4 56 Minimum investment return. Enter 5% of line 5 . . . . . . . . . . . . . . . . . 6

Part XI Distributable Amount (see page 25 of the instructions) (Section 4942(j)(3) and (j)(5) private operatingfoundations and certain foreign organizations check here and do not complete this part.)

1 Minimum investment return from Part X, line 6 . . . . . . . . . . . . . . . . . . 12a Tax on investment income for 2010 from Part VI, line 5 . . . . . . . 2a

b Income tax for 2010. (This does not include the tax from Part VI.) . . . 2bc Add lines 2a and 2b . . . . . . . . . . . . . . . . . . . . . . . . . . 2c

3 Distributable amount before adjustments. Subtract line 2c from line 1 . . . . . . . . . . 34 Recoveries of amounts treated as qualifying distributions . . . . . . . . . . . . . . 45 Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Deduction from distributable amount (see page 25 of the instructions) . . . . . . . . . . 67 Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,

line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Part XII Qualifying Distributions (see page 25 of the instructions)

1 Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:a Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 . . . . . . . . . 1ab Program-related investments—total from Part IX-B . . . . . . . . . . . . . . . . 1b

2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Amounts set aside for specific charitable projects that satisfy the:a Suitability test (prior IRS approval required) . . . . . . . . . . . . . . . . . . . 3ab Cash distribution test (attach the required schedule) . . . . . . . . . . . . . . . . 3b

4 Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4 45 Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment income.

Enter 1% of Part I, line 27b (see page 26 of the instructions) . . . . . . . . . . . . . 56 Adjusted qualifying distributions. Subtract line 5 from line 4 . . . . . . . . . . . . 6

Note. The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax in those years.

Form 990-PF (2010)


Form 990-PF (2010) Page 9 Part XIII Undistributed Income (see page 26 of the instructions)

(a) Corpus

(b) Years prior to 2009

(c) 2009

(d) 20101 Distributable amount for 2010 from Part XI,

line 7 . . . . . . . . . . . . .

2 Undistributed income, if any, as of the end of 2010:a Enter amount for 2009 only . . . . . .b Total for prior years: 20 ,20 ,20

3 Excess distributions carryover, if any, to 2010:a From 2005 . . . . . .b From 2006 . . . . . .c From 2007 . . . . . .d From 2008 . . . . . .e From 2009 . . . . . .f Total of lines 3a through e . . . . . .

4 Qualifying distributions for 2010 from Part XII, line 4: $

a Applied to 2009, but not more than line 2a .b Applied to undistributed income of prior years

(Election required—see page 26 of the instructions)c Treated as distributions out of corpus (Election

required—see page 26 of the instructions) .

d Applied to 2010 distributable amount . .e Remaining amount distributed out of corpus

5 Excess distributions carryover applied to 2010(If an amount appears in column (d), the same amount must be shown in column (a).)

6 Enter the net total of each column as indicated below:

a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5b Prior years’ undistributed income. Subtract

line 4b from line 2b . . . . . . . .

c

Enter the amount of prior years’ undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed . . . .

d Subtract line 6c from line 6b. Taxable amount—see page 27 of the instructions .

e

Undistributed income for 2009. Subtract line 4a from line 2a. Taxable amount—see page 27 of the instructions . . . . . . . .

f

Undistributed income for 2010. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2011 . . . . . . . . .

7

Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) (see page 27 of the instructions) . . . . . . . . . . .

8

Excess distributions carryover from 2005 not applied on line 5 or line 7 (see page 27 of the instructions) . . . . . . . . . . .

9 Excess distributions carryover to 2011. Subtract lines 7 and 8 from line 6a . . .

10 Analysis of line 9:a Excess from 2006 . . . .b Excess from 2007 . . . .c Excess from 2008 . . . .d Excess from 2009 . . . .e Excess from 2010 . . . .

Form 990-PF (2010)


Form 990-PF (2010) Page 10 Part XIV Private Operating Foundations (see page 27 of the instructions and Part VII-A, question 9)

1a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 2010, enter the date of the ruling . . . . . .

b Check box to indicate whether the foundation is a private operating foundation described in section 4942(j)(3) or 4942(j)(5)Tax year Prior 3 years

(a) 2010 (b) 2009 (c) 2008 (d) 2007(e) Total

2a

Enter the lesser of the adjusted net income from Part I or the minimum investment return from Part X for each year listed . . . . . . .

b 85% of line 2a . . . . . . .c Qualifying distributions from Part XII,

line 4 for each year listed . . . .

d Amounts included in line 2c not used directly for active conduct of exempt activities . .

e

Qualifying distributions made directly for active conduct of exempt activities. Subtract line 2d from line 2c . . .

3 Complete 3a, b, or c for the alternative test relied upon:

a “Assets” alternative test—enter:(1) Value of all assets . . . . .(2) Value of assets qualifying under

section 4942(j)(3)(B)(i) . . . .

b “Endowment” alternative test—enter 2/3 of minimum investment return shown in Part X, line 6 for each year listed . . .

c “Support” alternative test—enter:

(1)

Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties) . . . .

(2)

Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(iii) . . . .

(3) Largest amount of support from an exempt organization . . .

(4) Gross investment income . . .Part XV Supplementary Information (Complete this part only if the foundation had $5,000 or more in assets at

any time during the year—see page 28 of the instructions.)1 Information Regarding Foundation Managers:

a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundationbefore the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)

b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of theownership of a partnership or other entity) of which the foundation has a 10% or greater interest.

2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:Check here if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see page 28 of the instructions) to individuals or organizations under other conditions, complete items 2a, b, c, and d.

a The name, address, and telephone number of the person to whom applications should be addressed:

b The form in which applications should be submitted and information and materials they should include:

c Any submission deadlines:

d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:

Form 990-PF (2010)


Form 990-PF (2010) Page 11 Part XV Supplementary Information (continued)3 Grants and Contributions Paid During the Year or Approved for Future Payment

Recipient

Name and address (home or business)

If recipient is an individual, show any relationship to any foundation manager or substantial contributor

Foundation status of recipient

Purpose of grant or contribution

Amount

a Paid during the year

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3ab Approved for future payment

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3bForm 990-PF (2010)


Form 990-PF (2010) Page 12 Part XVI-A Analysis of Income-Producing Activities

Unrelated business income Excluded by section 512, 513, or 514Enter gross amounts unless otherwise indicated.

(a) Business code

(b) Amount

(c) Exclusion code

(d) Amount

(e) Related or exempt function income (See page 28 of the instructions.)1 Program service revenue:

abcdef

g Fees and contracts from government agencies2 Membership dues and assessments . . . .3 Interest on savings and temporary cash investments4 Dividends and interest from securities . . . .5 Net rental income or (loss) from real estate:

a Debt-financed property . . . . . . .Not debt-financed property . . . . . .b

6 Net rental income or (loss) from personal property7 Other investment income . . . . . . . .8 Gain or (loss) from sales of assets other than inventory9 Net income or (loss) from special events . . .

10 Gross profit or (loss) from sales of inventory . .11 Other revenue: a

bcde

12 Subtotal. Add columns (b), (d), and (e) . . . .13 Total. Add line 12, columns (b), (d), and (e) . . . . . . . . . . . . . . . . . . 13

(See worksheet in line 13 instructions on page 29 to verify calculations.)Part XVI-B Relationship of Activities to the Accomplishment of Exempt PurposesLine No. Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to the

accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See page 29 of the instructions.)

Form 990-PF (2010)

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✔ ✔

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Form 990-PF (2010) Page 13 Part XVII Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations1 Did the organization directly or indirectly engage in any of the following with any other organization described

in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

Yes No

a Transfers from the reporting foundation to a noncharitable exempt organization of:(1) Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a(1)(2) Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a(2)

b Other transactions:(1) Sales of assets to a noncharitable exempt organization . . . . . . . . . . . . . . . . 1b(1)(2) Purchases of assets from a noncharitable exempt organization . . . . . . . . . . . . . . 1b(2)(3) Rental of facilities, equipment, or other assets . . . . . . . . . . . . . . . . . . . 1b(3)(4) Reimbursement arrangements . . . . . . . . . . . . . . . . . . . . . . . . . 1b(4)(5) Loans or loan guarantees . . . . . . . . . . . . . . . . . . . . . . . . . . 1b(5)(6) Performance of services or membership or fundraising solicitations . . . . . . . . . . . . 1b(6)

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees . . . . . . . . . . 1cd If the answer to any of the above is “Yes,” complete the following schedule. Column (b) should always show the fair market

value of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

(a) Line no. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements

2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizationsdescribed in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? . . . . . . Yes No

b If “Yes,” complete the following schedule.(a) Name of organization (b) Type of organization (c) Description of relationship

Sign Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.

Signature of officer or trustee Date Title



PTIN

Firm’s name

Firm's address

Firm's EIN

Phone no.

Form 990-PF (2010)


Schedule B(Form 990, 990-EZ, or 990-PF)Department of the Treasury Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010Name of the organization Employer identification number

Organization type (check one):

Filers of: Section:

Form 990 or 990-EZ 501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF 501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 331/3 % support test of the regulations under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more during the year . . . . . . . . . . . . . . . . . . . . . . . . . . $

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box on line H of its Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF. Cat. No. 30613X Schedule B (Form 990, 990-EZ, or 990-PF) (2010)


Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page of of Part I


Part I Contributors (see instructions)

(a) No.




$



(a) No.




$



(a) No.




$



(a) No.




$



(a) No.




$



(a) No.




$





Form 990-TDepartment of the Treasury Internal Revenue Service

Exempt Organization Business Income Tax Return (and proxy tax under section 6033(e))

For calendar year 2010 or other tax year beginning , 2010, and

ending , 20 . See separate instructions.

OMB No. 1545-0687

2010Open to Public Inspection for 501(c)(3) Organizations Only

Print or

Type

Name of organization ( Check box if name changed and see instructions.)

Number, street, and room or suite no. If a P.O. box, see instructions.


A Check box if address changed

B Exempt under section501( ) ( )

408(e) 220(e)

408A 530(a)

529(a)

D Employer identification number (Employees’ trust, see instructions.)

E Unrelated business activity codes (See instructions.)

C Book value of all assets at end of year F Group exemption number (See instructions.)

G Check organization type 501(c) corporation 501(c) trust 401(a) trust Other trustH Describe the organization’s primary unrelated business activity. I During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? . . Yes No

If “Yes,” enter the name and identifying number of the parent corporation. J The books are in care of Telephone number Part I Unrelated Trade or Business Income (A) Income (B) Expenses (C) Net

1a Gross receipts or salesb Less returns and allowances c Balance 1c

2 Cost of goods sold (Schedule A, line 7) . . . . . . . 23 Gross profit. Subtract line 2 from line 1c . . . . . . . 34a Capital gain net income (attach Schedule D) . . . . . 4ab Net gain (loss) (Form 4797, Part II, line 17) (attach Form 4797) 4bc Capital loss deduction for trusts . . . . . . . . . 4c

5 Income (loss) from partnerships and S corporations (attach statement) 56 Rent income (Schedule C) . . . . . . . . . . . 67 Unrelated debt-financed income (Schedule E) . . . . . 78 Interest, annuities, royalties, and rents from controlled

organizations (Schedule F) . . . . . . . . . . . 89 Investment income of a section 501(c)(7), (9), or (17)

organization (Schedule G) . . . . . . . . . . . 910 Exploited exempt activity income (Schedule I) . . . . . 1011 Advertising income (Schedule J) . . . . . . . . . 1112 Other income (See instructions; attach schedule.) . . . . . 1213 Total. Combine lines 3 through 12 . . . . . . . . 13Part II Deductions Not Taken Elsewhere (See instructions for limitations on deductions.) (Except for contributions,

deductions must be directly connected with the unrelated business income.)14 Compensation of officers, directors, and trustees (Schedule K) . . . . . . . . . . . . 1415 Salaries and wages . . . . . . . . . . . . . . . . . . . . . . . . . . 1516 Repairs and maintenance . . . . . . . . . . . . . . . . . . . . . . . . 1617 Bad debts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1718 Interest (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . 1819 Taxes and licenses . . . . . . . . . . . . . . . . . . . . . . . . . . . 1920 Charitable contributions (See instructions for limitation rules.) . . . . . . . . . . . . . 2021 Depreciation (attach Form 4562) . . . . . . . . . . . . . 2122 Less depreciation claimed on Schedule A and elsewhere on return . . 22a 22b23 Depletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2324 Contributions to deferred compensation plans . . . . . . . . . . . . . . . . . 2425 Employee benefit programs . . . . . . . . . . . . . . . . . . . . . . . . 2526 Excess exempt expenses (Schedule I) . . . . . . . . . . . . . . . . . . . . 2627 Excess readership costs (Schedule J) . . . . . . . . . . . . . . . . . . . . 2728 Other deductions (attach schedule) . . . . . . . . . . . . . . . . . . . . . 2829 Total deductions. Add lines 14 through 28 . . . . . . . . . . . . . . . . . . 2930 Unrelated business taxable income before net operating loss deduction. Subtract line 29 from line 13 3031 Net operating loss deduction (limited to the amount on line 30) . . . . . . . . . . . . 3132 Unrelated business taxable income before specific deduction. Subtract line 31 from line 30 . . . 3233 Specific deduction (Generally $1,000, but see line 33 instructions for exceptions.) . . . . . . 3334 Unrelated business taxable income. Subtract line 33 from line 32. If line 33 is greater than line 32,

enter the smaller of zero or line 32 . . . . . . . . . . . . . . . . . . . . . . 34For Paperwork Reduction Act Notice, see instructions. Cat. No. 11291J Form 990-T (2010)

RR8169_ADJ


Form 990-T (2010) Page 2Part III Tax Computation35 Organizations Taxable as Corporations. See instructions for tax computation. Controlled group

members (sections 1561 and 1563) check here See instructions and:a Enter your share of the $50,000, $25,000, and $9,925,000 taxable income brackets (in that order):

(1) $ (2) $ (3) $b Enter organization’s share of: (1) Additional 5% tax (not more than $11,750) $

(2) Additional 3% tax (not more than $100,000) . . . . . . . . . $c Income tax on the amount on line 34 . . . . . . . . . . . . . . . . . . . . 35c

36 Trusts Taxable at Trust Rates. See instructions for tax computation. Income tax onthe amount on line 34 from: Tax rate schedule or Schedule D (Form 1041) . . . . . 36

37 Proxy tax. See instructions . . . . . . . . . . . . . . . . . . . . . . . 3738 Alternative minimum tax . . . . . . . . . . . . . . . . . . . . . . . . . 3839 Total. Add lines 37 and 38 to line 35c or 36, whichever applies . . . . . . . . . . . . 39Part IV Tax and Payments40a Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116) . 40a

b Other credits (see instructions) . . . . . . . . . . . . . . . 40bc General business credit. Attach Form 3800 . . . . . . . . . . . 40cd Credit for prior year minimum tax (attach Form 8801 or 8827) . . . . . 40de Total credits. Add lines 40a through 40d . . . . . . . . . . . . . . . . . . . 40e

41 Subtract line 40e from line 39 . . . . . . . . . . . . . . . . . . . . . . . 4142 Other taxes. Check if from: Form 4255 Form 8611 Form 8697 Form 8866 Other (attach schedule) . 4243 Total tax. Add lines 41 and 42 . . . . . . . . . . . . . . . . . . . . . . . 4344a Payments: A 2009 overpayment credited to 2010 . . . . . . . . 44a

b 2010 estimated tax payments . . . . . . . . . . . . . . . 44bc Tax deposited with Form 8868 . . . . . . . . . . . . . . . 44cd Foreign organizations: Tax paid or withheld at source (see instructions) . 44de Backup withholding (see instructions) . . . . . . . . . . . . 44ef Credit for small employer health insurance premiums (Attach Form 8941) . 44fg Other credits and payments: Form 2439

Form 4136 Other Total 44g45 Total payments. Add lines 44a through 44g . . . . . . . . . . . . . . . . . . 4546 Estimated tax penalty (see instructions). Check if Form 2220 is attached . . . . . . . . 4647 Tax due. If line 45 is less than the total of lines 43 and 46, enter amount owed . . . . . . 4748 Overpayment. If line 45 is larger than the total of lines 43 and 46, enter amount overpaid . . 4849 Enter the amount of line 48 you want: Credited to 2011 estimated tax Refunded 49Part V Statements Regarding Certain Activities and Other Information (see instructions)

1 At any time during the 2010 calendar year, did the organization have an interest in or a signature or other authority over a financial account (bank, securities, or other) in a foreign country? If YES, the organization may have to file Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts. If YES, enter the name of the foreign country here

Yes No

2 During the tax year, did the organization receive a distribution from, or was it the grantor of, or transferor to, a foreign trust? .If YES, see instructions for other forms the organization may have to file.

3 Enter the amount of tax-exempt interest received or accrued during the tax year $Schedule A—Cost of Goods Sold. Enter method of inventory valuation

1 Inventory at beginning of year 12 Purchases . . . . . . 23 Cost of labor . . . . . . 34a Additional section 263A costs

(attach schedule) . . . . 4ab Other costs (attach schedule) 4b

5 Total. Add lines 1 through 4b 5

6 Inventory at end of year . . . 67 Cost of goods sold. Subtract

line 6 from line 5. Enter here and in Part I, line 2 . . . . . . 7

8 Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization? . . . . . . . . .

Yes No

Sign Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Signature of officer Date Title

May the S discuss this return with the preparer shown below (see instructions)? Yes No



PTIN

Firm’s name

Firm’s address

Firm's EIN

Phone no.

Form 990-T (2010)

PREPARER (Y/N)


Form 990-T (2010) Page 3Schedule C—Rent Income (From Real Property and Personal Property Leased With Real Property)

(see instructions)1. Description of property

(1)

(2)

(3)

(4)

2. Rent received or accrued

(a) From personal property (if the percentage of rent for personal property is more than 10% but not

more than 50%)

(b) From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)

3(a) Deductions directly connected with the income in columns 2(a) and 2(b) (attach schedule)

(1)

(2)

(3)

(4)

Total Total

(c) Total income. Add totals of columns 2(a) and 2(b). Enter here and on page 1, Part I, line 6, column (A) . . .

(b) Total deductions. Enter here and on page 1, Part I, line 6, column (B)

Schedule E—Unrelated Debt-Financed Income (see instructions)

1. Description of debt-financed property2. Gross income from or

allocable to debt-financed property

3. Deductions directly connected with or allocable to debt-financed property

(a) Straight line depreciation (attach schedule)

(b) Other deductions (attach schedule)

(1)

(2)

(3)

(4)4. Amount of average acquisition debt on or

allocable to debt-financed property (attach schedule)

5. Average adjusted basis of or allocable to

debt-financed property (attach schedule)

6. Column 4 divided

by column 5

7. Gross income reportable (column 2 × column 6)

8. Allocable deductions (column 6 × total of columns

3(a) and 3(b))

(1) %(2) %(3) %(4) %

Totals . . . . . . . . . . . . . . . . . . . . . . . . .

Enter here and on page 1, Part I, line 7, column (A).

Enter here and on page 1, Part I, line 7, column (B).

Total dividends-received deductions included in column 8 . . . . . . . . . . . . . . . . .

Schedule F—Interest, Annuities, Royalties, and Rents From Controlled Organizations (see instructions)

1. Name of controlled organization

2. Employer identification number

Exempt Controlled Organizations

3. Net unrelated income (loss) (see instructions)

4. Total of specified payments made

5. Part of column 4 that is included in the controlling

organization’s gross income

6. Deductions directly connected with income

in column 5

(1)

(2)

(3)

(4)

Nonexempt Controlled Organizations

7. Taxable Income 8. Net unrelated income (loss) (see instructions)

9. Total of specified payments made

10. Part of column 9 that is included in the controlling

organization’s gross income

11. Deductions directly connected with income in

column 10

(1)

(2)

(3)

(4)

Totals . . . . . . . . . . . . . . . . . . . . . . . . . .

Add columns 5 and 10. Enter here and on page 1, Part I, line 8, column (A).

Add columns 6 and 11. Enter here and on page 1, Part I, line 8, column (B).

Form 990-T (2010)

Offi i l U O l


Form 990-T (2010) Page 4Schedule G—Investment Income of a Section 501(c)(7), (9), or (17) Organization (see instructions)

1. Description of income 2. Amount of income3. Deductions

directly connected (attach schedule)

4. Set-asides (attach schedule)

5. Total deductions and set-asides (col. 3

plus col. 4)

(1)

(2)

(3)

(4)

Totals . . . . . . . .

Enter here and on page 1, Part I, line 9, column (A).

Enter here and on page 1, Part I, line 9, column (B).

Schedule I—Exploited Exempt Activity Income, Other Than Advertising Income (see instructions)

1. Description of exploited activity

2. Gross unrelated

business income from trade or

business

3. Expenses directly

connected with production of

unrelated business income

4. Net income (loss) from

unrelated trade or business (column 2 minus column

3). If a gain, compute cols. 5

through 7.

5. Gross income from activity that is not unrelated

business income

6. Expenses attributable to

column 5

7. Excess exempt expenses

(column 6 minus column 5, but not

more than column 4).

(1)

(2)

(3)

(4)

Totals . . . . . . . . .

Enter here and on page 1, Part I, line 10, col. (A).

Enter here and on page 1, Part I,

line 10, col. (B).

Enter here and on page 1,

Part II, line 26.

Schedule J—Advertising Income (see instructions)Part I Income From Periodicals Reported on a Consolidated Basis

1. Name of periodical2. Gross

advertising income

3. Direct advertising costs

4. Advertising gain or (loss) (col. 2 minus col. 3). If a gain, compute

cols. 5 through 7.

5. Circulation income

6. Readership costs

7. Excess readership costs (column 6

minus column 5, but not more than

column 4).

(1)

(2)

(3)

(4)

Totals (carry to Part II, line (5)) . .

Part II Income From Periodicals Reported on a Separate Basis (For each periodical listed in Part II, fill in columns 2 through 7 on a line-by-line basis.)

1. Name of periodical2. Gross

advertising income

3. Direct advertising costs

4. Advertising gain or (loss) (col. 2 minus col. 3). If a gain, compute

cols. 5 through 7.

5. Circulation income

6. Readership costs

7. Excess readership costs (column 6

minus column 5, but not more than

column 4).

(1)

(2)

(3)

(4)

Totals from Part I

Totals, Part II (lines 1-5) . . . .

Enter here and on page 1, Part I, line 11, col. (A).

Enter here and on page 1, Part I,

line 11, col. (B).

Enter here and on page 1,

Part II, line 27.

Schedule K—Compensation of Officers, Directors, and Trustees (see instructions)

1. Name 2. Title3. Percent of

time devoted to business

4. Compensation attributable to unrelated business

(1) %(2) %(3) %(4) %Total. Enter here and on page 1, Part II, line 14 . . . . . . . . . . . . . . . . . . .

Form 990-T (2010)

✔



Return of Certain Excise Taxes Under Chapters 41 and 42 of the Internal Revenue Code

(Sections 170(f)(10), 664(c)(2), 4911, 4912, 4941, 4942, 4943, 4944, 4945, 4955, 4958, 4965, 4966, and 4967) See separate Instructions.

OMB No. 1545-0052

2010For calendar year 2010 or other tax year beginning , 2010, and ending , 20

Name of organization or entity Employer identification number

Number, street, and room or suite no. (or P.O. box if mail is not delivered to street address)


Check box for type of annual return:

Form 990

Form 990-PF

Form 5227

Form 990-EZ

Yes No

A Is the organization a foreign private foundation within the meaning of section 4948(b)? . . . . . . . . .B Has corrective action been taken on any taxable event that resulted in Chapter 42 taxes being reported on this

form? (Enter “N/A” if not applicable) . . . . . . . . . . . . . . . . . . . . . . . . . .

If “Yes,” attach a detailed description and documentation of the corrective action taken and, if applicable, enter the fair market value of any property recovered as a result of the correction . If “No,” (i.e., any uncorrected acts, or transactions), attach an explanation (see page 4 of the instructions).

$

Part I Taxes on Organization (Sections 170(f)(10), 664(c)(2), 4911(a), 4912(a), 4942(a), 4943(a), 4944(a)(1), 4945(a)(1), 4955(a)(1), 4965(a)(1), and 4966(a)(1))

1 Tax on undistributed income—Schedule B, line 4 . . . . . . . . . . . . . . . 12 Tax on excess business holdings—Schedule C, line 7 . . . . . . . . . . . . . 23 Tax on investments that jeopardize charitable purpose—Schedule D, Part I, column (e) . . 34 Tax on taxable expenditures—Schedule E, Part I, column (g) . . . . . . . . . . . 45 Tax on political expenditures—Schedule F, Part I, column (e) . . . . . . . . . . . 56 Tax on excess lobbying expenditures—Schedule G, line 4 . . . . . . . . . . . . 67 Tax on disqualifying lobbying expenditures—Schedule H, Part I, column (e) . . . . . . 78 Tax on premiums paid on personal benefit contracts . . . . . . . . . . . . . 89 Tax on being a party to prohibited tax shelter transactions—Schedule J, Part I, column (h) . 9

10 Tax on taxable distributions—Schedule K, Part I, column (f) . . . . . . . . . . . 1011 Tax on a charitable remainder trust’s unrelated business taxable income. Attach schedule . 1112 Total (add lines 1–11) . . . . . . . . . . . . . . . . . . . . . . . . 12

Part II-ATaxes on Managers, Self-Dealers, Disqualified Persons, Donors, Donor Advisors, and Related Persons (Sections 4912(b), 4941(a), 4944(a)(2), 4945(a)(2), 4955(a)(2), 4958(a), 4965(a)(2), 4966(a)(2), and 4967(a))

(a) Name and address of person subject to tax (b) Taxpayer identification number

abcd

(c) Tax on self-dealing—Schedule A, Part II, col. (d), and Part III, col. (d)

(d) Tax on investments that jeopardize charitable purpose—Schedule D,

Part II, col. (d)

(e) Tax on taxable expenditures— Schedule E, Part II, col. (d)

(f) Tax on political expenditures— Schedule F, Part II, col. (d)

abcdTotal

(g) Tax on disqualifying lobbying expenditures—Schedule H, Part II, col. (d)

(h) Tax on excess benefit transactions—Schedule I, Part II, col.

(d), and Part III, col. (d)

(i) Tax on being a party to prohibited tax shelter transactions—Schedule J,

Part II, col. (d)

(j) Tax on taxable distributions— Schedule K, Part II, col. (d)

abcdTotal

(k) Tax on prohibited benefits—Sch L, Part II, col. (d), and Part III, col. (d)

(l) Total—Add cols. (c) through (k)

abcd

TotalFor Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 13021D Form 4720 (2010)


Form 4720 (2010) Page 2Part II-B Summary of Taxes (See Tax Payments on page 3 of the instructions.)

1 Enter the taxes listed in Part II-A, column (l), that apply to managers, self-dealers, disqualifiedpersons, donors, donor advisors, and related persons who sign this form. If all sign, enter thetotal amount from Part II-A, column (l) . . . . . . . . . . . . . . . . . . 1

2 Total tax. Add Part I, line 12, and Part II-B, line 1. (Make check(s) or money order(s) payable to the United States Treasury.) If payment was made with Form 8868, see the instructions . 2

SCHEDULE A—Initial Taxes on Self-Dealing (Section 4941)Part I Acts of Self-Dealing and Tax Computation(a) Act number

(b) Date of act

(c) Description of act

12345

(d) Question number from Form 990-PF, Part VII-B, or Form 5227, Part VI-B,

applicable to the act(e) Amount involved in act

(f) Initial tax on self-dealing (10% of col. (e))

(g) Tax on foundation managers (if applicable) (lesser of $20,000 or 5% of

col. (e))

Part II Summary of Tax Liability of Self-Dealers and Proration of Payments

(a) Names of self-dealers liable for tax(b) Act no. from

Part I, col. (a)(c) Tax from Part I, col. (f),

or prorated amount

(d) Self-dealer’s total tax liability (add amounts in col. (c)) (see page 6 of the instructions)

Part III Summary of Tax Liability of Foundation Managers and Proration of Payments

(a) Names of foundation managers liable for tax(b) Act no. from

Part I, col. (a)(c) Tax from Part I, col. (g),

or prorated amount

(d) Manager’s total tax liability (add amounts in col. (c))

(see page 7 of the instructions)

SCHEDULE B—Initial Tax on Undistributed Income (Section 4942)1 Undistributed income for years before 2009 (from Form 990-PF for 2010, Part XIII, line 6d) . 12 Undistributed income for 2009 (from Form 990-PF for 2010, Part XIII, line 6e) . . . . . 23 Total undistributed income at end of current tax year beginning in 2010 and subject to tax

under section 4942 (add lines 1 and 2) . . . . . . . . . . . . . . . . . . 34 Tax— Enter 30% of line 3 here and on page 1, Part I, line 1 . . . . . . . . . . . 4

Form 4720 (2010)


Form 4720 (2010) Page 3SCHEDULE C—Initial Tax on Excess Business Holdings (Section 4943)

Business Holdings and Computation of TaxIf you have taxable excess holdings in more than one business enterprise, attach a separate schedule for each enterprise. Refer to the instructions on page 7 for each line item before making any entries.Name and address of business enterprise

Employer identification number . . . . . . . . . . . . . . . . . . . .

Form of enterprise (corporation, partnership, trust, joint venture, sole proprietorship, etc.) . (a)

Voting stock (profits interest or beneficial interest)

(b) Value

(c) Nonvoting stock (capital interest)

1 Foundation holdings in business enterprise . . 1 % %

2 Permitted holdings in business enterprise . . 2 % %

3 Value of excess holdings in business enterprise 34

Value of excess holdings disposed of within 90 days; or, other value of excess holdings not subject to section 4943 tax (attach explanation) 4

5

Taxable excess holdings in business enterprise— line 3 minus line 4 . . . . . . . . . . 5

6 Tax—Enter 10% of line 5 . . . . . . . . 67

Total tax— Add amounts on line 6, columns (a), (b), and (c); enter total here and on page 1, Part I, line 2 7

SCHEDULE D—Initial Taxes on Investments That Jeopardize Charitable Purpose (Section 4944)Part I Investments and Tax Computation

(a) Investment number

(b) Date of investment

(c) Description of investment(d) Amount of

investment

(e) Initial tax on foundation (10% of

col. (d))

(f) Initial tax on foundation managers (if applicable)— (lesser of $10,000 or 10%

of col. (d))

12345

Total— column (e). Enter here and on page 1, Part I, line 3 . . . . . . . . . .Total— column (f). Enter total (or prorated amount) here and in Part II, column (c), below . . . . . .Part II Summary of Tax Liability of Foundation Managers and Proration of Payments

(a) Names of foundation managers liable for tax (b) Investment no. from Part I,

col. (a)

(c) Tax from Part I, col. (f), or prorated amount



Form 4720 (2010)


Form 4720 (2010) Page 4SCHEDULE E—Initial Taxes on Taxable Expenditures (Section 4945)

Part I Expenditures and Computation of Tax(a) Item number

(b) Amount(c) Date paid or incurred

(d) Name and address of recipient(e) Description of expenditure and purposes

for which made

12345

(f) Question number from Form 990-PF, Part VII-B, or Form 5227, Part VI-B, applicable to the expenditure

(g) Initial tax imposed on foundation (20% of col. (b))

(h) Initial tax imposed on foundation managers (if applicable)—(lesser of

$10,000 or 5% of col. (b))

Total— column (g). Enter here and on page 1, Part I, line 4 . . . . . . . .Total— column (h). Enter total (or prorated amount) here and in Part II, column (c), below . . . . . . . . . . . . . . . . . . . . . . . . .

Part II Summary of Tax Liability of Foundation Managers and Proration of Payments

(a) Names of foundation managers liable for tax(b) Item no. from

Part I, col. (a)(c) Tax from Part I, col. (h), or

prorated amount



SCHEDULE F—Initial Taxes on Political Expenditures (Section 4955)Part I Expenditures and Computation of Tax

(a) Item number

(b) Amount(c) Date paid or incurred

(d) Description of political expenditure(e) Initial tax imposed on

organization or foundation (10% of col. (b))

(f) Initial tax imposed on managers (if applicable) (lesser of $5,000 or 2½% of col. (b))

12345

Total— column (e). Enter here and on page 1, Part I, line 5 . . . . . . .

Total— column (f). Enter total (or prorated amount) here and in Part II, column (c), below . . . . .Part II Summary of Tax Liability of Organization Managers or Foundation Managers and Proration of Payments

(a) Names of organization managers or foundation managers liable for tax

(b) Item no. from Part I, col. (a)

(c) Tax from Part I, col. (f), or prorated amount



Form 4720 (2010)


Form 4720 (2010) Page 5SCHEDULE G—Tax on Excess Lobbying Expenditures (Section 4911)

1 Excess of grassroots expenditures over grassroots nontaxable amount (from Schedule C (Form990 or 990-EZ), Part II-A, column (b), line 1h). (See page 11 of the instructions before making entry.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Excess of lobbying expenditures over lobbying nontaxable amount (from Schedule C (Form 990 or 990-EZ), Part II-A, column (b), line 1i). (See page 11 of the instructions before making entry.) . . 2

3 Taxable lobbying expenditures—enter the larger of line 1 or line 2 . . . . . . . . . . . 3

4 Tax— Enter 25% of line 3 here and on page 1, Part I, line 6 . . . . . . . . . . . . . 4SCHEDULE H—Taxes on Disqualifying Lobbying Expenditures (Section 4912)

Part I Expenditures and Computation of Tax(a) Item number

(b) Amount(c) Date paid or

incurred(d) Description of lobbying expenditures

(e) Tax imposed on organization (5% of col. (b))

(f) Tax imposed on organization managers (if applicable)—

(5% of col. (b))

12345

Total— column (e). Enter here and on page 1, Part I, line 7 . . . . . .

Total— column (f). Enter total (or prorated amount) here and in Part II, column (c), below . . . . . .Part II Summary of Tax Liability of Organization Managers and Proration of Payments

(a) Names of organization managers liable for tax(b) Item no. from

Part I, col. (a)(c) Tax from Part I, col. (f), or

prorated amount



SCHEDULE I—Initial Taxes on Excess Benefit Transactions (Section 4958)Part I Excess Benefit Transactions and Tax Computation

(a) Transaction

number(b) Date of transaction (c) Description of transaction

12345

(d) Amount of excess benefit(e) Initial tax on disqualified persons

(25% of col. (d))

(f) Tax on organization managers (if applicable) (lesser of

$20,000 or 10% of col. (d))

Form 4720 (2010)


Form 4720 (2010) Page 6SCHEDULE I—Initial Taxes on Excess Benefit Transactions (Section 4958) Continued

Part II Summary of Tax Liability of Disqualified Persons and Proration of Payments

(a) Names of disqualified persons liable for tax(b) Trans. no. from

Part I, col. (a)(c) Tax from Part I, col. (e),

or prorated amount

(d) Disqualified person’s total tax liability (add amounts in col. (c)) (see

page 13 of the instructions)

Part III Summary of Tax Liability of 501(c)(3), (c)(4) & (29) Organization Managers and Proration of Payments

(a) Names of 501(c)(3), (c)(4) & (29) organization managers liable for tax(b) Trans. no. from

Part I, col. (a)(c) Tax from Part I, col. (f),

or prorated amount



SCHEDULE J—Taxes on Being a Party to Prohibited Tax Shelter Transactions (Section 4965)

Part I Prohibited Tax Shelter Transactions (PTST) and Tax Imposed on the Tax-Exempt Entity (see page 13 of the instructions)

(a) Transaction

number

(b) Transaction date

(c) Type of transaction 1 —Listed 2 —Subsequently listed 3 —Confidential 4 —Contractual protection

(d) Description of transaction

1

2

3

4

5

(e) Did the tax-exempt entity know or have reason to know this transaction

was a PTST when it became a party to the trans.? Answer Yes or No

(f) Net income attributable to the PTST

(g) 75% of proceeds attributable to the PTST

(h) Tax imposed on the tax-exempt entity (see page 14 of the instructions)

Total— column (h). Enter here and on page 1, Part I, line 9 . . . . . . . . . . . . .Form 4720 (2010)


Form 4720 (2010) Page 7Part II Tax Imposed on Entity Managers (Section 4965) Continued

(a) Name of entity manager(b) Transaction number from Part I, col. (a)

(c) Tax—enter $20,000 for each transaction listed in col. (b) for each

manager in col. (a)


SCHEDULE K—Taxes on Taxable Distributions of Sponsoring Organizations Maintaining Donor Advised Funds (Section 4966). See page 14 of the instructions.

Part I Taxable Distributions and Tax Computation(a)

Item number(b) Name of sponsoring organization and

donor advised fund(c) Description of distribution

1

2

3

4

(d) Date of distribution (e) Amount of distribution(f) Tax imposed on

organization (20% of col. (e))

(g) Tax on fund managers (lesser of 5% of col. (e) or

$10,000)

Total— column (f). Enter here and on page 1, Part I, line 10 . . .Total— column (g). Enter total (or prorated amount) here and in Part II, column (c), below . .Part II Summary of Tax Liability of Fund Managers and Proration of Payments

(a) Name of fund managers liable for tax(b) Item no. from

Part I, col. (a)(c) Tax from Part I, col. (g) or prorated

amount


(see instructions)

Form 4720 (2010)


Form 4720 (2010) Page 8SCHEDULE L—Taxes on Prohibited Benefits Distributed From Donor Advised Funds (Section 4967).

See page 14 of the instructions.Part I Prohibited Benefits and Tax Computation

(a) Item number

(b) Date of prohibited benefit

(c) Description of benefit

1

2

3

4

5

(d) Amount of prohibited benefit(e) Tax on prohibited benefit (125% of col. (d))

(see instructions)(f) Tax on fund managers (if applicable) (lesser of 10% of col.

(d) or $10,000) (see instructions)

Part II Summary of Tax Liability of Donors, Donor Advisors, Related Persons and Proration of Payments

(a) Names of donors, donor advisor, or related persons liable for tax

(b) Item no. from Part I, col. (a)

(c) Tax from Part I, col. (e) or prorated amount

(d) Donor, donor advisor, or related persons total tax liability (add amounts in col. (c)) (see instructions)

Part III Tax Liability of Fund Managers and Proration of Payments

(a) Names of fund managers liable for tax(b) Item no. from

Part I, col. (a)(c) Tax from Part I, col. (f) or

prorated amount(d) Fund managers total tax liability (add

amounts in col. (c)) (see instructions)

Form 4720 (2010)


Form 4720 (2010) Page 9

Sign Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Signature of officer or trustee Title Date

Signature (and organization or entity name if applicable) of manager, self-dealer, disqualified person, donor, donor advisor, or related person

Date


Date


Date


Date


Print/Type preparer’s name Preparer’s signature DateCheck if self- employed

PTIN

Firm’s name

Firm’s address

Firm's EIN

Phone no.

Form 4720 (2010)



Split-Interest Trust Information Return


OMB No. 1545-0196

2010Open to Public

Inspection Full name of trust

Name of trustee

Number, street, and room or suite no. (If a P.O. box, see page 3 of the instructions.)


A Employer identification number

B Type of Entity

(1) Charitable lead trust

(2) Charitable remainder annuity trust described in section 664(d)(1)

(3) Charitable remainder unitrust described in section 664(d)(2)

(4) Pooled income fund described in section 642(c)(5)

(5) Other—Attach explanationC Fair market value (FMV) of assets at end of tax year D Gross Income

E Check applicable boxes (see instructions)

Initial return Final return Amended return

Change in trustee’s Name Address

F Date the trust was created

G If the trust is a section 664 trust, did it have unrelated business taxable income? If “Yes,” file Form 4720 Yes No

Part I Income and Deductions (All trusts complete Sections A through D) Section A—Ordinary Income

1 Interest income . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2a Ordinary dividends (including qualified dividends) . . . . . . . . . . . . . . . . 2a b Qualified dividends (see page 4 of the instructions) . . . . . . . 2b

3 Business income or (loss). Attach Schedule C or C-EZ (Form 1040) . . . . . . . . . . . 3 4 Rents, royalties, partnerships, other estates and trusts, etc. Attach Schedule E (Form 1040) . . 4 5 Farm income or (loss). Attach Schedule F (Form 1040) . . . . . . . . . . . . . . . 5 6 Ordinary gain or (loss). Attach Form 4797 . . . . . . . . . . . . . . . . . . . 6 7 Other income. List type and amount 7 8 Total ordinary income. Combine lines 1, 2a, and 3 through 7 . . . . . . . . . . . 8

Section B—Capital Gains (Losses) 9 Total short-term capital gain or (loss). Attach Schedule D, Part I (Form 1041) . . . . . . . 9

10 Total long-term capital gain or (loss). Attach Schedule D, Part II (Form 1041) . . . . . . . . 10 11 Unrecaptured section 1250 gain . . . . . . . . . . . . . 11 12 28% gain . . . . . . . . . . . . . . . . . . . . . 12 13 Total capital gains (losses). Combine lines 9 and 10 . . . . . . . . . . . . . . 13

Section C—Nontaxable Income 14 Tax-exempt interest . . . . . . . . . . . . . . . . . . . . . . . . . . 14 15 Other nontaxable income. List type and amount

15 16 Total nontaxable income. Add lines 14 and 15 . . . . . . . . . . . . . . . . 16

Section D—Deductions 17 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 18 Taxes (see page 5 of the instructions) . . . . . . . . . . . . . . . . . . . . 18 19 Trustee fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 20 Attorney, accountant, and return preparer fees . . . . . . . . . . . . . . . . . 20 21 Other allowable deductions. Attach schedule (see page 5 of the instructions) . . . . . . . 21 22 Total. Add lines 17 through 21 . . . . . . . . . . . . . . . . . . . . . . . 22 23 Charitable deduction . . . . . . . . . . . . . . . . . 23

Section E—Deductions Allocable to Income Categories (Section 664 trust only) 24a Enter the amount from line 22 allocable to ordinary income . . . . . . . . . . . . . 24a

b Subtract line 24a from line 8 . . . . . . . . . . . . . . . . . . . . . . . 24b 25 a Enter the amount from line 22 allocable to capital gains (losses) . . . . . . . . . . . . 25a

b Subtract line 25a from line 13 . . . . . . . . . . . . . . . . . . . . . . . 25b 26 a Enter the amount from line 22 allocable to nontaxable income . . . . . . . . . . . . 26a

b Subtract line 26a from line 16 . . . . . . . . . . . . . . . . . . . . . . . 26b For Paperwork Reduction Act Notice, see the instructions. Cat. No. 13227T Form 5227 (2010)


Form 5227 (2010) Page 2

Part II Schedule of Distributable Income (Section 664 trust only) See page 6 of the instructions

Accumulations (a) Ordinary

income (b) Capital gains

(losses) (c) Nontaxable

income

27 Undistributed income from prior tax years . . . . . . . .

28

Current tax year net income (before distributions): • In column (a), enter the amount from line 24b • In column (b), enter the amount from line 25b • In column (c), enter the amount from line 26b

29 Total distributable income. Add lines 27 and 28 . . . . . .

Part III-A Distributions of Principal for Charitable Purposes

30 Principal distributed in prior tax years for charitable purposes . . . . . . . . . . . . 30 31 Principal distributed during the current tax year for charitable purposes. Fill in the information for

columns (A), (B), and (C) and enter the amount distributed on the space to the right. (see page 6 of the instructions)

(A) Payee’s name and address

(B) Date of distribution

(C) Charitable purpose and description of assets distributed

a 31a b

31b c 31c

32 Total. Add lines 30 through 31c . . . . . . . . . . . . . . . . . . . . . . 32

Part III-B Accumulated Income Set Aside and Income Distributions for Charitable Purposes (see page 6 of the instructions)

33a Accumulated income set aside in prior tax years for which a deduction was claimed under section 642(c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33a

b Enter the amount shown on line 23 . . . . . . . . . . . . . . . . . . . . . 33b 34 Add lines 33a and 33b . . . . . . . . . . . . . . . . . . . . . . . . . 34 35 Distributions made during the tax year (see page 6 of the instructions):

• For income set aside in prior tax years for which a deduction was claimed under section 642(c), or

• For charitable purposes for which a charitable deduction was claimed under section 642(c) inthe current tax year.

Fill in the information for columns (A), (B), and (C) and enter the amount distributed on the line to the right.

(A) Payee’s name and address

(B) Date of distribution

(C) Charitable purpose and description of assets distributed

a 35a b 35b c 35c

36 Add lines 35a through 35c . . . . . . . . . . . . . . . . . . . . . . . . 36 37 Carryover. Subtract line 36 from line 34 . . . . . . . . . . . . . . . . . . . . 37

Form 5227 (2010)


Form 5227 (2010) Page 3 Part IV Balance Sheet (see pages 6 through 8 of the instructions)

Assets (a) Beginning-of- Year Book Value

(b) End-of-Year Book Value

(c) FMV (see instructions)

38 Cash—non-interest-bearing . . . . . . . . . . . . . . . 38 39 Savings and temporary cash investments . . . . . . . . . . 39 40a Accounts receivable . . . . . . . . . . 40a

b Less: allowance for doubtful accounts . . . . 40b 41

Receivables due from officers, directors, trustees, and other disqualified persons (attach schedule) . . . . . . . . . . . 41

42a Other notes and loans receivable . . . . . 42a b Less: allowance for doubtful accounts . . . 42b

43 Inventories for sale or use . . . . . . . . . . . . . . . 43 44 Prepaid expenses and deferred charges . . . . . . . . . . 44 45a

Investments—U.S. and state government obligations (attach schedule) . . . . . . . . . . . . . . . . . . . . . 45a

b Investments—corporate stock. Attach schedule . . . . . . . . 45b c Investments—corporate bonds. Attach schedule . . . . . . . . 45c

46a

Investments—land, buildings, and equipment: basis (attach schedule) . . . . . . . . 46a

b Less: accumulated depreciation . . . . . 46b 47 Investments—other (attach schedule) . . . . . . . . . . . 47 48a Land, buildings, and equipment: basis . . . 48a

b Less: accumulated depreciation . . . . . 48b 49 Other assets. Describe 49 50 Total assets. Add lines 38 through 49 (must equal line 60) . . . 50

Liabilities 51 Accounts payable and accrued expenses . . . . . . . . . . 51 52 Deferred revenue . . . . . . . . . . . . . . . . . . 52 53 Loans from officers, directors, trustees, and other disqualified persons 53 54 Mortgages and other notes payable. Attach schedule . . . . . . 54 55 Other liabilities. Describe 55 56 Total liabilities. Add lines 51 through 55 . . . . . . . . . 56

Net Assets 57 Trust principal or corpus . . . . . . . . . . . . . . . . 57 58a Undistributed income . . . . . . . . . . . . . . . . . 58a

b Undistributed capital gains . . . . . . . . . . . . . . . 58b c Undistributed nontaxable income . . . . . . . . . . . . . 58c

59 Total net assets. Add lines 57 through 58c . . . . . . . . . 59 60 Total liabilities and net assets. Add lines 56 and 59 . . . . . . 60

Form 5227 (2010)


Form 5227 (2010) Page 4 Part V-A Charitable Remainder Annuity Trust (CRAT) Information (to be completed only by a section

664 CRAT) 61 a Enter the initial fair market value (FMV) of the property placed in the trust . . . . . . . . . . 61a

b Enter the total annual annuity amounts for all recipients . . . . . . . . . . . . . . . 61b Part V-B Charitable Remainder Unitrust (CRUT) Information (to be completed only by a section 664 CRUT)

See page 8 of the instructions 62 Is the CRUT a net income charitable remainder unitrust (NICRUT) as described in Regulations section

1.664-3(a)(1)(i)(b)(1)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No 63 Is the CRUT a net income with make-up charitable remainder unitrust (NIMCRUT) as described in Regulations

section 1.664-3(a)(1)(i)(b)(2)? . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No 64 Did the trust change its method of payment during the tax year? . . . . . . . . . . . . . . Yes No

If “Yes,” describe the triggering event including the date of the event and the old method of payment

65 a Enter the unitrust fixed percentage to be paid to the recipients . . . . . . . . . . . . . 65a % b Unitrust amount. Subtract line 56, column (c), from line 50, column (c), and multiply the result by the

percentage on line 65a. Do not enter less than -0- . . . . . . . . . . . . . . . . . 65b If the answer is “Yes” on line 62 or line 63, go to line 66a. Otherwise, skip lines 66a through 67b and enter the line 65b amount on line 68.

66a Trust’s accounting income for 2010. Attach schedule . . . . . . . . . . . . . . . . 66a If the answer is “Yes” on line 62, go to line 66b. If the answer is “Yes” on line 63, skip line 66b and go to line 67a.

b Enter the smaller of line 65b or line 66a here and on line 68. Skip lines 67a and 67b . . . . . . 66b 67a Total accumulated distribution deficiencies from previous years (see page 8 of the instructions) . . 67a

b Add lines 65b and 67a . . . . . . . . . . . . . . . . . . . . . . . . . . 67b If lines 67a and 67b are completed, enter the smaller of line 66a or line 67b on line 68.

68 Required unitrust distribution for 2010 . . . . . . . . . . . . . . . . . . . . . 68 69 Carryover of accumulated distribution deficiency (only for trusts that answered “Yes” on line 63).

Subtract line 68 from line 67b . . . . . . . . . . . . . . . . . . . . . . . . 69 70 If this is the final return, enter the initial FMV of all assets placed in trust by the donor . . . . . . 70 71 Did the trustee change the method of determining the fair market value of the assets? . . . . . . . Yes No

If “Yes,” attach an explanation. 72 Were any additional contributions received by the trust during 2010? . . . . . . . . . . . . . Yes No

If “Yes,” be sure to complete all columns of line 7 in Schedule A, Part III. Part VI-A Statements Regarding Activities (see page 8 of the instructions) 73 Are the requirements of section 508(e) satisfied either: Yes No

• By the language in the governing instrument; or • By state legislation that effectively amends the governing instrument so that no mandatory directionsthat conflict with the state law remain in the governing instrument? . . . . . . . . . . . . . . 73

74 Are you using this return only to report the income and assets of a segregated amount under section4947(a)(2)(B)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Form 5227 (2010)


Form 5227 (2010) Page 5 Part VI-B Statements Regarding Activities for Which Form 4720 May Be Required

File Form 4720 if any item is checked in the “Yes” column (to the right), unless an exception applies. Yes No 75 Self-dealing (section 4941):

a During 2010, did the trust (either directly or indirectly): (1) Engage in the sale or exchange, or leasing of property with a disqualified person? Yes No (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified person? . . . . . . . . . . . . . . . . . . . . . Yes No (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? . Yes No (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? . Yes No (5) Transfer any income or assets to a disqualified person (or make any of either available

for the benefit or use of a disqualified person)? . . . . . . . . . . . . . Yes No (6) Agree to pay money or property to a government official? (Exception. Check “No” if

the trust agreed to make a grant to or to employ the official for a period after termination of government service, if terminating within 90 days.) . . . . . . . . . . . . Yes No

b If any answer is “Yes” to 75a(1) through (6), did any of the acts fail to qualify under the exceptions described in Regulations sections 53.4941(d)-3 and 4, or in a current Notice regarding disaster assistance (see page 9 of the instructions)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75b Organizations relying on a current Notice regarding disaster assistance, check here . . . .

c Did the trust engage in a prior year in any of the acts described in 75a, other than excepted acts, that were not corrected before January 1, 2010? . . . . . . . . . . . . . . . . . . . . . . . 75c

76 Does section 4947(b)(3)(A) or (B) apply? (See page 9 of the instructions.) . . . . . . Yes No If “Yes,” check the “N/A” box in questions 77 and 78.

77 Taxes on excess business holdings (section 4943): N/A a Did the trust hold more than a 2% direct or indirect interest in any business enterprise at

any time during 2010? . . . . . . . . . . . . . . . . . . . . . . Yes No b If “Yes,” did the trust have excess business holdings in 2010 as a result of (1) any purchase by the trust or

disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse of the 10-, 15-, or 20-year first phase holding period? . . . . . . . . . . . . . . 77b Use Schedule C, Form 4720, to determine if the trust had excess business holdings in 2010.

78 Taxes on investments that jeopardize charitable purposes (section 4944): N/A a Did the trust invest during 2010 any amount in a manner that would jeopardize its charitable purpose? . . 78a b Did the trust make any investment in a prior year (but after December 31, 1969) that could jeopardize its

charitable purpose that had not been removed from jeopardy before January 1, 2010? . . . . . . . 78b 79 Taxes on taxable expenditures (section 4945) and political expenditures (section 4955):

a During 2010, did the trust pay or incur any amount to: (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? . Yes No (2) Influence the outcome of any specific public election (see section 4955); or to carry

on, directly or indirectly, any voter registration drive? . . . . . . . . . . . Yes No (3) Provide a grant to an individual for travel, study, or other similar purposes? . . . . Yes No (4) Provide a grant to an organization other than a charitable, etc., organization described

in section 509(a)(1), (2), or (3), or section 4940(d)(2)? . . . . . . . . . . . . Yes No (5) Provide for any purpose other than religious, charitable, scientific, literary, or

educational, or for the prevention of cruelty to children or animals? . . . . . . Yes No b If any answer is “Yes” to 79a(1) through (5), did any of the transactions fail to qualify under the exceptions

described in Regulations section 53.4945, or in a current Notice regarding disaster assistance (see page 9of the instructions)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79b Organizations relying on a current Notice regarding disaster assistance, check here . . . .

c If the answer is “Yes” to question 79a(4), does the trust claim exemption from the tax because it maintained expenditure responsibility for the grant? (See page 9 of the instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No If “Yes,” attach the statement required by Regulations section 53.4945-5(d).

80 Personal benefit contracts (section 170(f)(10)): a Did the trust, during the year, receive any funds, directly or indirectly, to pay premiums on

a personal benefit contract? . . . . . . . . . . . . . . . . . . . . Yes No b Did the trust, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . . 80b

If “Yes” to 80b, file Form 8870 (see page 9 of the instructions.) Form 5227 (2010)


Form 5227 (2010) Page 6

Part VII Questionnaire for Charitable Lead Trusts, Pooled Income Funds, and Charitable Remainder Trusts (see instructions beginning on page 9)

Section A—All Trusts

81 Check this box if any of the split-interest trust’s income interests expired during 2010 . . . . . . . . . 82 Check this box if all of the split-interest trust’s income interests expired before 2010 . . . . . . . . . .

If 82 (above) is checked and this is not a final return, attach an explanation.

Section B—Charitable Lead Trusts

83 Does the governing instrument require income in excess of the required annuity or unitrust payments to be paid for charitable purposes? . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

84 Enter the amount of any excess income required to be paid for charitable purposes for 2010 . . . 84 85 Enter the amount of annuity or unitrust payments required to be paid to charitable beneficiaries for 2010 . 85

Section C—Pooled Income Funds

86 Enter the amount of contributions received during 2010 . . . . . . . . . . . . . . 86

87 Enter the amount required to be distributed for 2010 to satisfy the remainder interest . . . . . 87 88 Enter any amounts that were required to be distributed to the remainder beneficiary that remain

undistributed . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

89 Enter the amount of income required to be paid to the charitable remainder beneficiary for 2010 . 89

Section D—Charitable Remainder Trusts

90 Check this box if you are filing for a charitable remainder annuity trust or a charitable remainder unitrust whose charitable interests involve only cemeteries or war veterans’ posts . . . . . . . . . . . . . . . .

91 Check this box if you are making an election under Regulations section 1.664-2(a)(1)(i)(a)(2) or 1.664-3(a)(1)(i)(g)(2) to treat income generated from certain property distributions (other than cash) by the trust as occurring on the last day of the tax year. (See page 10 of the instructions.) . . . . . . . . . . . . . . . . . . . . . .

92 Is this the initial return? If “Yes,” attach a copy of the trust instrument . . . . . . . . . . . . . Yes No 93 Was the trust instrument amended during the year? If “Yes,” attach a copy . . . . . . . . . . . Yes No 94a If this is the final return, were final distributions made according to the trust instrument? . . . . . . . Yes No

b If “Yes,” did you complete line 31? . . . . . . . . . . . . . . . . . . . . . . . . Yes No c If either line 94a or 94b is “No,” explain why

95 At any time during calendar year 2010, did the trust have an interest in or a signature or other authority over a bank, securities, or other financial account in a foreign country? . . . . . . . . . . . . . . . Yes No See the instructions beginning on page 10 for exceptions and filing requirements for Form TD F 90-22.1. If “Yes,” enter the name of the foreign country

Sign Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than trustee) is based on all information of which preparerhas any knowledge.

Signature of trustee or officer representing trustee Date



PTIN

Firm’s name

Firm’s address

Firm's EIN

Phone no.

Form 5227 (2010)


Form 5227 (2010) Page 7 Full name of trust Employer identification number

NOT Open To Public Inspection

Schedule A—Distributions, Assets, and Donor Information

Part I Accumulation Schedule (Section 664 trust only) See page 10 of the instructions

Accumulations (a)

Ordinary income (b)

Capital gain (loss) (c)

Nontaxable income

1 Total distributable income. Enter the amount from line 29 . . .2a Total distributions for 2010: b 2010 distributions from income . . . . . . . . . . .

3 Undistributed income at end of tax year. Subtract line 2b from line 1 . . . . . . . . . . . . . . . . . . . .

Part II-A Current Distributions Schedule (Section 664 trust only) See instructions beginning on page 10

(a) Name of recipient

(b) Identifying number

(c) Percentage of total unitrust

amount payable (if applicable)

4a %

b %

c %

(d) Ordinary Income

Capital gains (g)

Nontaxable Income (h)

Corpus

(i) Total (add cols. (d) through (h) (e) Short-term (f) Long-term

4a b c

Total If Part II-A, Total, column (i) does not agree with line 61b of Form 5227 for a CRAT or line 68 of Form 5227 for a CRUT, check here and attach an explanation.

Part II-B Current Distributions (charitable lead trusts or pooled income funds only) See page 12 of the instructions 5 Enter the amount required to be paid to private beneficiaries for 2010 . . . . . . . . . .

Part III Assets and Donor Information (Section 664 trust or charitable lead trust only) 6 Is this the initial return or were additional assets contributed to the trust in 2010? . . . . . . . . . Yes No

If “Yes,” complete the schedule below. If “No,” complete only column (a) of the schedule below.

(a) Name and address of donor

(b) Description of each asset donated

(c) Fair market value of each asset on date of donation

(d) Date of donation

7a

7b

7c 7d Total . . . . . . . . . . . . . . . . . . . 8 For charitable remainder trusts: If this was the final year, was an early termination agreement

signed by all parties to the trust? . . . . . . . . . . . . . . . . . . . . . . Yes No N/A If “Yes,” attach a copy of the signed agreement.

Form 5227 (2010)

301Tax-Exempt Bonds Programs

Information Return for T ax-ExemptPrivate Activity Bond Issues

8038 Form OMB No. 1545-0720

(Under Internal Revenue Code section 149(e)) Department of the TreasuryInternal Revenue Service

� See separate instructions. Check if Amended Return � Reporting Authority

2 Issuer’s employer identification number (EIN) 1 Issuer’s name

4 3 Number and street (or P.O. box if mail is not delivered to street address)

6 Date of issue 5 City, town, or post office, state, and ZIP code

8 CUSIP number 7 Name of issue

Issue Price Type of Issue (Enter the issue price for each) Exempt facility bond:

11 11a a Airport (sections 142(a)(1) and 142(c))

11b b Docks and wharves (sections 142(a)(2) and 142(c))

11d d Water furnishing facilities (sections 142(a)(4) and 142(e))

11e e

Sewage facilities (section 142(a)(5))

11f f Solid waste disposal facilities (section 142(a)(6))

Qualified residential rental projects (sections 142(a)(7) and 142(d)) (see instructions)Meeting 20–50 test (section 142(d)(1)(A))

Meeting 40–60 test (section 142(d)(1)(B)) Meeting 25–60 test (NYC only) (section 142(d)(6))

Has an election been made for deep rent skewing (section 142(d)(4)(B))?

No Yes 11g Facilities for the local furnishing of electric energy or gas (sections 142(a)(8) and 142(f))

h

i

11h Facilities allowed under a transitional rule of the Tax Reform Act of 1986 (see instructions) Facility type

1986 Act section

11j

Qualified mortgage bond (section 143(a))

13 Qualified veterans’ mortgage bond (section 143(b)) (see instructions) �

Check the box if you elect to rebate arbitrage profits to the United States 14 Qualified small issue bond (section 144(a)) (see instructions) �

12a

Check the box for $10 million small issue exemption

16 Qualified student loan bond (section 144(b))

13

17 Qualified redevelopment bond (section 144(c))

14

18 Qualified hospital bond (section 145(c)) (attach schedule—see instructions)

15

Qualified 501(c)(3) nonhospital bond (section 145(b)) (attach schedule—see instructions)

16

19 Check box if 95% or more of net proceeds will be used only for capital expenditures �

17 18

Description of Bonds (Complete for the entire issue for which this form is being filed.) (c) Stated redemption

price at maturity

(d) Weightedaverage maturity

(e) Yield

(b) Issue price

(a) Final maturity date

years % 21 $ $

Form 8038 (Rev. 6-2010) For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.

Part III

Part I

Part II

Cat. No. 49973K

(Rev. June 2010)

Room/suite

Qualified enterprise zone facility bonds (section 1394) (see instructions)

11i

10 Telephone number of officer or other person

9 Name and title of officer of the issuer or other person whom the IRS may call for more information

( )

c 11c

g

20a Nongovernmental output property bond (treated as private activity bond) (section 141(d))

19

j Qualified empowerment zone facility bonds (section 1394(f)) (see instructions)

m Qualified green building and sustainable design projects (sections 142(a)(14) and 142(l))

11m

12a

15

k District of Columbia Enterprise Zone facility bonds (section 1400A)

11k

l Qualified public educational facility bonds (sections 142(a)(13) and 142(k))

11l

n Qualified highway or surface freight transfer facilities (sections 142(a)(15) and 142(m))

11n

o p q

Qualified New York Liberty bonds (section 1400L(d)) �

11p 11q

b

20b Other. Describe (see instructions) �

20c b c

Other (see instructions) New York Liberty Zone advance refunding bond (section 1400L(e)) (see instructions)

Other (see instructions)



Report number (For IRS Use Only) 1

12b

302 Tax-Exempt Bonds Programs

Form 8038 (Rev. 6-2010) Page 2 Uses of Proceeds of Issue (including underwriters’ discount) Amount

22 Proceeds used for accrued interest

22 23 Issue price of entire issue (enter amount from line 21, column (b))

23

24 24 Proceeds used for bond issuance costs (including underwriters’ discount) 25 Proceeds used for credit enhancement

25

26 Proceeds allocated to reasonably required reserve or replacement fund

26 27 27

29 Add lines 24 through 28

29 Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount here)

30 30

Description of Property Financed by Nonrefunding Proceeds

31 Type of Property Financed by Nonrefunding Proceeds: 31a a Land

31b b Buildings and structures 31c Equipment with recovery period of more than 5 years

c

31d Equipment with recovery period of 5 years or less

d e 31e

North American Industry Classification System (NAICS) of the projects financed by nonrefunding proceeds. 32 Amount of nonrefunding proceeds NAICS Code Amount of nonrefunding proceeds NAICS Code

a c b d

Description of Refunded Bonds (Complete this part only for refunding bonds.) years Enter the remaining weighted average maturity of the bonds to be currently refunded �

33

Enter the last date on which the refunded bonds will be called �

35 Enter the date(s) the refunded bonds were issued �

36 Miscellaneous

Name of governmental unit(s) approving issue (see the instructions) �

37

Check the box if you have designated any issue under section 265(b)(3)(B)(i)(III) �

38

Volume Caps 42 Amount of state volume cap allocated to the issuer. Attach copy of state certification

42

43 43 Amount of issue subject to the unified state volume cap 44 Amount of issue not subject to the unified state volume cap or other volume limitations:

a Of bonds for governmentally owned solid waste facilities, airports, docks, wharves, environmentalenhancements of hydroelectric generating facilities, or high-speed intercity rail facilities

44

44a b Under a carryforward election. Attach a copy of Form 8328 to this return

44b

c Under transitional rules of the Tax Reform Act of 1986. Enter Act section �

44c Under the exception for current refunding (section 146(i) and section 1313(a) of the Tax Reform Act of 1986)

d 44d

45a 45b 46a

45a Amount of issue of qualified veterans’ mortgage bonds b Enter the state limit on qualified veterans’ mortgage bonds

Under penalties of perjury, I declare that I have examined this return, and accompanying schedules and statements, and to the best of my knowledgeand belief, they are true, correct, and complete. I further declare that I consent to the IRS’s disclosure of the issuer’s return information, as necessaryto process this return, to the person that I have authorized above.

SignatureandConsent Date Signature of issuer’s authorized representative

Part VIII

Part VII

Part VI

Part V

Part IV

Amount

Amount

� �

Check the box if you have elected to pay a penalty in lieu of arbitrage rebate �

39

$ $

$

$

Check the box if you have identified a hedge (see instructions) �

40

Caution: The total of lines 31a through e below must equal line 30 above. Do not complete for qualified student loanbonds, qualified mortgage bonds, or qualified veterans’ mortgage bonds.

46a Amount of section 1394(f) volume cap allocated to issuer. Attach copy of local government certification b Name of empowerment zone �

28 Proceeds used to currently refund prior issue (complete Part VI)

Proceeds used to advance refund prior issue (complete Part VI)

28

Enter the remaining weighted average maturity of the bonds to be advance refunded �

34 years

47 Amount of section 142(k)(5) volume cap allocated to issuer. Attach copy of state certification

47

Check the box if the issue is comprised of qualified redevelopment, qualified small issue, or exempt facilities bonds andprovide name and IN of the primary private user �

41

Name �

EIN

Form 8038 (Rev. 6-2010)

Preparer’s SSN or PTIN Date Preparer’ssignature

Check ifself-employed



EIN

Phone no.

� � ( )


Other. Describe (see instructions) �


Form 8038-B(January 2010)Department of the Treasury Internal Revenue Service

Information Return for Build America Bonds and Recovery Zone Economic Development Bonds

� Under Internal Revenue Code section 149(e)� See separate instructions.

OMB No. 1545-2161

Part I Reporting Authority Check if Amended Return �

1 Issuer’s name 2 Issuer’s employer identification number (EIN)

3 Name of person (other than issuer) with whom the IRS may communicate about this return (see instructions) 4 Report number (For IRS Use Only)

5 Number and street (or P.O. Box if mail is not delivered to street address)

6 City, town, or post office, state, and ZIP code 7 Date of issue (MM/DD/YYYY)

/ /8 Name of issue 9 CUSIP number

10 Name and title of officer of issuer whom the IRS may call for more information (see instructions) 11 Telephone number of officer or other person (see instructions)

Part II Type of Bonds (see instructions, if the box on line 1b or 1c is checked, complete lines 2 and 3)1 a Build America bonds (Tax Credit) (section 54AA(a)) . . . . . . . . . . . . . . . . . . . . . . .

b Build America bonds (Direct Payment) (sections 54AA(g) and 6431) . . . . . . . . . . . . . . . . . . c Recovery zone economic development bonds (Direct Payment) (sections 1400U-2 and 6431) . . . . . . . . .

2 Enter the first interest payment date (MM/DD/YYYY) � / /3 Interest payment date frequency: (Check box) (see instructions and attach debt service schedule)

a annual,b semi-annual,c quarterly,d monthly, ore otherf If line 3e above is checked, please describe the payment frequency:

Part III Purpose of Issue1 For a build America bond, identify the purpose of issue and enter the issue price. (see instructions

and attach schedule) Amount

(Whole Dollars)

a Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1ab Health and hospital . . . . . . . . . . . . . . . . . . . . . . . . . . 1bc Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1cd Public safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1de Environment (including sewage bonds) . . . . . . . . . . . . . . . . . . . . 1ef Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1fg Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1gh Other description � 1h

2 For a recovery zone economic development bond, identify the purpose of issue and enter the issueprice. (see instructions and attach schedule)

a Capital expenditures relating to property located in the zone . . . . . . . . . . . . . 2ab Public infrastructure and construction of public facilities . . . . . . . . . . . . . . 2bc Job training and educational programs . . . . . . . . . . . . . . . . . . . . 2cd Other description . . . . . . . . . . . . . . . . . . . . . . . . . . . 2d

3 Total issue price (Part III, lines 1a through 1h or lines 2a through 2d) . . . . . . . . . . 34 If obligations are TANs or RANs, check only box 4a � If obligations are BANs, check only box 4b �5 If obligations are in the form of a lease or installment sale, check box �

Part IV Description of Obligations (Complete for the entire issue for which this form is being filed.)1 Stated redemption price at maturity . . . . . . . . . . . . . . . . . . . . . 12 Final maturity date (MM/DD/YYYY) . . . . . . . . . . . . . . / /3 Weighted average maturity . . . . . . . . . . . . . . years4 Yield . . . . . . . . . . . . . . . . . . . %5 If the issue is a variable rate issue, check box 5a � Please indicate the frequency rates are reset 5b �

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 53393K Form 8038-B (1-2010)

1

-


Form 8038-B (1-2010) Page 2

Part V Use of Proceeds of Issue Amount (Whole Dollars)

1 Sales proceeds . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Expected investment proceeds . . . . . . . . . . . . . . . . . . . . . . 23 Proceeds used for accrued interest . . . . . . . . . . . . . . . . . . . . . 34 Proceeds used for bond issuance cost (including underwriter's discount) . . . . . . . . . 45 Proceeds used for credit enhancement . . . . . . . . . . . . . . . . . . . . 56 Proceeds allocated to a reasonably required reserve fund . . . . . . . . . . . . . . 67 Proceeds used for capital expenditures . . . . . . . . . . . . . . . . . . . . 78 Proceeds used for working capital expenditures . . . . . . . . . . . . . . . . . 89 Proceeds used to currently refund prior issues . . . . . . . . . . . . . . . . . 9

10 Proceeds used to advance refund prior issues . . . . . . . . . . . . . . . . . 10Part VI Description of Refunded Bonds (complete this part only for refunding bonds)

1 Enter the remaining weighted average maturity of the bonds to be currently refunded . . . . . . . . . . . . . . . . . years

2 Enter the remaining weighted average maturity of the bonds to be advance refunded . . . . . . . . . . . . . . . . .

/ /years

3 Enter the last date on which the refunded bonds will be called (MM/DD/YYYY) 4 Enter the date the refunded bonds were issued (if more than one date of issue, attach a schedule)

(MM/DD/YYYY) (see instructions) . . . . . . . . . . . . / /Part VII Miscellaneous

1 Enter the amount of the volume cap allocated to the issue (see instructions) (attach volume cap certification) 12a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract

(GIC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2ab Enter the final maturity date of the GIC (MM/DD/YYYY) � / /c Enter the name of the GIC provider �

3 Proceeds of this issue that are to be used to make loans to other governmental units . . . . . 34a If this issue is a loan made from the proceeds of another issue, check box � and enter the following information:

b Enter the issue date of the master pool obligation (MM/DD/YYYY) � / /c Enter the EIN of the issuer of the master pool obligation �

d Enter the name of the issuer of the master pool obligation � 5a If the issuer entered into a hedge, check box � and enter the following information:

b Name of hedge provider � c Type of hedge � d Term of hedge �

6 If the issuer has superintegrated the hedge, check box �

7 If the issuer elected to pay a penalty in lieu of arbitrage rebate, check box �

8 If the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remediated in accordance with the requirements under Regulations section 1.141-12, check box �

9 If the issuer has established written procedures to monitor the requirements of section 148, check box �

Signature and Consent

Under penalties of perjury, I declare that I have examined this return, and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. I further declare that I consent to the IRS's disclosure of the issuer's return information, as necessary to process the return, to the person(s) that I have authorized above.

� Signature of issuer's authorized representative Date � Type or print name and title

Paid Preparer’s Use Only

Preparer’s signature �

Date Check if self- employed


Firm’s name (or yours if self-employed), address, and ZIP code

� EIN

Phone no.

Part VIII Consent to Disclosure of Certain Information from this Return

1 For build America bonds that provide a tax credit to bondholders, does the issuer give the IRS consent to publish, through a website or in a publication, its name and address, employer identification number, name and description of bond issue, date of issuance, CUSIP number, issue price, final maturity date, and stated redemption price at maturity, to assist in the proper reporting of interest, tax credits, or other benefits under section 6049 and Regulations thereunder? . . . . . . � Yes No

Under penalties of perjury, I declare that I am an officer of the above named issuer and that I am authorized to give consent on behalf of the above named issuer for the IRS to publish the items of information described in line 1 of Part VIII of this form to assist in the reporting obligations under section 6049.

Sign Here � Signature Date � Type or print name and title

Form 8038-B (1-2010)


8038-CP Form Return for Credit Paymentsto Issuers of Qualified Bonds

OMB No. 1545-2142

(Rev. June 2010) Department of the TreasuryInternal Revenue Service Information on Entity That Is To Receive Payment of Credit and Communications

2

1

EIN

Issuer’s name (if same as line 1, enter “SAME” and skip lines 8, 9, 11, 15, and 16)

3

Number and street (or P.O. box no. if mail is not delivered to street address)

4

Date of issue (MM/DD/YYYY)

City, town, or post office, state, and ZIP code

CUSIP number (See instructions.)

Name of issue

8

5

Reporting Authority

Type of issue �

Employer identification number (EIN)

13

15

Under penalties of perjury, I declare that I have examined this return, and accompanying schedules and statements, and to the best of my knowledgeand belief, they are true, correct, and complete. I further declare that I authorize the IRS to send the requested refundable credit payment to the entityidentified in Part I, and I consent to the disclosure of the issuer’s return information, as necessary to process the refundable credit payment, to thedesignated contact person(s) listed above in Parts I and II, as applicable.

Signature andConsent

Signature of issuer Type or print name and title Date

Form 8038-CP (Rev. 6-2010)

Part I

Part II

�

Cat. No. 52810E

Room/suite

17a

11

18 19a

21

Is this the final interest payment date?

22

Name of entity that is to receive payment of the credit

12

�

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Telephone number of officer or other person to call

Name and title of officer or other person whom the IRS may call for more information

10

7

( )

20

23

a

Build America bonds. Multiply line 19a by 35% (0.35) b

Recovery zone economic development bonds. Multiply line 19a by 45% (0.45)

19a

Number and street (or P.O. box no. if mail is not delivered to street address)

City, town, or post office, state, and ZIP code

Payment of Credit (For specified tax credit bonds with multiple maturities, see instructions.) Part III

Name and title of designated contact person whom the IRS may call for more information

Telephone number of officer or legal representative

Interest payment date to which this payment of credit relates (MM/DD/YYYY) Interest payable to bondholders on the interest payment date

Amount of credit payment to be received as of the interest payment date (complete only line 20a, 20b,20c, 20d, 20e, or 20f):

Adjustment to previous credit payments (complete line 21a OR line 21b only):

Amount of credit payment to be received. Combine either line 20a, 20b, 20c, 20d, 20e, or 20f with line 21a or line 21b

22

20a

For build America bonds and recovery zone economic development bonds, check the applicable box (see instructions)

20b

( )

Yes

o





EIN

Phone no.

� � ( )

a

Net increase to previous payments (attach explanation) Net decrease to previous payments (attach explanation)

b

21a 21b

6

9

Room/suite

Report number (For IRS Use Only)

14

16

8

( )

Check box if Amended Return �

24

If the entity identified in Part I is not the issuer, check this box �

Check applicable box �

Variable rate bond

Fixed rate bond

25 Enter direct deposit information below: DirectDeposit

Routing number Account number

b

Checking

Savings

a c

�

Type:

/ /

/ /

b

For specified tax credit bonds only, enter the applicable credit rate determined under Sec. 54A(b)(3) %

Transportation

Health and Hospital

Educational

Public Safety

Environmental

Housing

Utilities

Other For build America bonds, recovery zone economic development bonds, and specified tax credit bonds, enter the issue price �

17b

. For specified tax credit bonds only, enter the interest that would be payable to bondholders on the interest

payment date calculated using the applicable credit rate (see instructions)

19c

Qualified zone academy bonds enter the lesser of lines 19a or 19c

e Qualified school construction bonds enter the lesser of lines 19a or 19c

f

New clean renewable energy bonds enter the lesser of line 19a or 70% of line 19c

c d

Qualified energy conservation bonds enter the lesser of line 19a or 70% of line 19c 20e

20f

20c 20d

b c

c


8038-G

Form OMB No. 1545-0720


If Amended Return, check here � Reporting Authority 2 Issuer’s employer identification number (EIN) 1 Issuer’s name

4 Report number (For IRS Use Only) 3 Number and street (or P.O. box if mail is not delivered to street address) 3

6 Date of issue 5 City, town, or post office, state, and ZIP code

8 CUSIP number 7 Name of issue

Part I

(Rev. May 2010)

Room/suite

10 Telephone number of officer or other person

9 Name and title of officer of the issuer or other person whom the IRS may call for more information

( )

Information Return for T ax-Exempt Governmental Obligations � Under Internal Revenue Code section 149(e)

� See separate instructions. Caution: If the issue price is under $100,000, use Form 8038-GC.

Type of Issue (enter the issue price) See instructions and attach schedule

If obligations are in the form of a lease or installment sale, check box �

Education

11 Health and hospital

12 13 Transportation

Public safety

14 Environment (including sewage bonds)

15

Housing

16 Utilities

19

Other. Describe �

20

Description of Obligations. Complete for the entire issue for which this form is being filed.

(e) Yield

(d) Weightedaverage maturity

(a) Final maturity date

(b) Issue price

(c) Stated redemptionprice at maturity

$ % years

Uses of Proceeds of Bond Issue (including underwriters’ discount) 22 Proceeds used for accrued interest

21

23 Issue price of entire issue (enter amount from line 21, column (b))

22

24 Proceeds used for bond issuance costs (including underwriters’ discount)

23

25 Proceeds used for credit enhancement

24

26 Proceeds allocated to reasonably required reserve or replacement fund

25

27 Proceeds used to currently refund prior issues

26

Total (add lines 24 through 28)

29 29 Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount here)

30 30

Description of Refunded Bonds (Complete this part only for refunding bonds.) years Enter the remaining weighted average maturity of the bonds to be currently refunded �

31

33 Enter the last date on which the refunded bonds will be called (MM/DD/YYYY) �

Enter the date(s) the refunded bonds were issued � (MM/DD/YYYY)

34

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Form 8038-G (Rev. 5-2010)

Part III

Part V

Part IV

Part II

Cat. No. 63773S

11 12 13 14 15 16

28 Proceeds used to advance refund prior issues

28

years Enter the remaining weighted average maturity of the bonds to be advance refunded �

32

17 18

17 18

$

27

If obligations are TANs or RANs, check only box 19a �

If obligations are BANs, check only box 19b �


Form 8038-G (Rev. 5-2010) Page 2

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. I further declare that I consent to the IRS’s disclosure of the issuer’s return information, as necessary to process this return, to the person that I have authorized above.

Signatureand Consent Date Signature of issuer’s authorized representative Type or print name and title � �

Form 8038-G (Rev. 5-2010)





EIN

Phone no.

� � ( )

Miscellaneous Enter the amount of the state volume cap allocated to the issue under section 141(b)(5)

35 35

Pooled financings: a Proceeds of this issue that are to be used to make loans to othergovernmental units

37

If this issue is a loan made from the proceeds of another tax-exempt issue, check box � and enter the name of the issuer �

Part VI 35

37a

36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (GIC) (see instructions)

b Enter the final maturity date of the GIC �

36a

b and the date of the issue �

If the issuer has designated the issue under section 265(b)(3)(B)(i)(III) (small issuer exception), check box �

38 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box �

39 If the issuer has identified a hedge, check box �


Form 8038-TC(June 2010)Department of the Treasury Internal Revenue Service

Information Return for Tax Credit Bonds and Specified Tax Credit Bonds

▶ Under Internal Revenue Code section 149(e)▶ See separate instructions.

OMB No. 1545-2160

Part I Reporting Authority Check if Amended Return ▶

1 Issuer’s name 2 Issuer’s employer identification number (EIN)

3 Name of person (other than the issuer) with whom the IRS may communicate about this return (See instructions.) 4 Report number (For IRS Use Only)

5 Number and street (or P.O. Box if mail is not delivered to street address)

6 City, town, or post office, state, and ZIP code 7 Date of issue (MM/DD/YYYY)

/ /8 Name of issue 9 CUSIP number

10 Name and title of officer of issuer whom the IRS may call for more information (See instructions.) 11 Telephone number of officer or other person

Part II Type of Issue1 Tax Credit Bond Code (See instructions, enter three digit code for the type of issue) . . . . . . . . ▶

2 Description:3 Has the issuer made an irrevocable election to apply section 6431(f)? Yes No4 Enter the first interest payment date (MM/DD/YYYY) ▶ / /5 Interest payment date frequency (Check box; see instructions and attach debt service schedule):

a annual,b semi-annual,c quarterly,d monthly, ore otherf If line 5e above is checked, please describe the payment frequency:

Part III Description of Obligations1 Issue price . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Stated redemption price at maturity . . . . . . . . . . . . . . . . . . . . 23 Final maturity date (enter date MM/DD/YYYY) ▶ / /4 Applicable credit rate . . . . . . . . . . . . . . . . . . . . . . . . 4 . %5 Maximum term . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . years6 Permitted Sinking Fund Yield . . . . . . . . . . . . . . . . . . . 6 . %7 Enter the interest rate on the bonds . . . . . . . . . . . . . . . . . 7 . %8 If the issue is a variable rate issue, check box 8a ▶ Enter the frequency rates are reset 8b ▶ .

Part IV Proceeds of Issue (Including underwriters' discount) Amount1 Sale Proceeds . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Proceeds used for bond issuance cost (including underwriters' discount) . . . . . . . . 23 Estimated investment proceeds . . . . . . . . . . . . . . . . . . . . . 34 Expected available project proceeds (Subtract line 2 from line 1 and add line 3) . . . . . . 45 Matching pledged funds . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Other (describe) ▶ 67 Total proceeds (Add lines 4 through 6) . . . . . . . . . . . . . . . . . . . 7

Part V Description of Use of Proceeds for Qualified Purpose Expenditures Amount1a Loans to qualified borrower(s) . . . . . . . . . . . . . . . . . . . . . . 1a

b If a written loan commitment was obtained prior to issue date, check box ▶

c Name of borrower ▶

d EIN of borrower ▶ (Attach list if more than one)2 Land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Buildings and structures . . . . . . . . . . . . . . . . . . . . . . . . 3

45 Furniture or equipment with recovery period of 5 years or less . . . . . . . . . . . 56 Grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Demonstration projects . . . . . . . . . . . . . . . . . . . . . . . . 78 Public education campaigns . . . . . . . . . . . . . . . . . . . . . . 89 Repairs or other rehabilitation expenditures . . . . . . . . . . . . . . . . . 9

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 53394V Form 8038-TC (6-2010)

4 Furniture or equipment with recovery period of more than 5 years . . . . . . . . . .


Form 8038-TC (6-2010) Page 2 Description of Use of Proceeds for Qualified Purpose Expenditures (Continued)10 Developing course materials and/or staff training expenditures . . . . . . . . . . . 1011 Pay principal, interest, or premiums on qualified bonds . . . . . . . . . . . . . . 1112 Refinance a qualified indebtedness . . . . . . . . . . . . . . . . . . . . 1213 Other (describe) ▶ 1314 Total qualified purpose expenditures (Sum of lines 1a through 13) . . . . . . . . . . 14

15 Percentage of total proceeds to be used for qualified purpose expenditures (Divide line14 in Part V by line 7 in Part IV, multiply result by 100) . . . . . . . . . . . . 15 . %

16 If some portion of proceeds was used to reimburse issuer for amounts paid for a qualified purpose, enter the amount of reimbursement . . . . . . . . . . . . . . . . . 16

17 If some portion of proceeds was to reimburse issuer for amounts paid for a qualified purpose, enter the date the official intent was adopted (MM/DD/YYYY) ▶ / / 17

Part VI Allocation of National, State, Tribal, or Local Bond Limitation Amount (Enter source and amount of allocation and attach copy of certificate) Amount

1a Volume cap allocation amount . . . . . . . . . . . . . . . . . . . . . . 1aYear of Allocation . . . . . Amount of Carryforward . . .

b National, check box . . . . . . . ▶ Local, check box . . . . . ▶

c State, check box . . . . . . . . . . . . . . . . . . . . . . . ▶

d Tribal, check box . . . . . . . . . . . . . . . . . . . . . . . ▶2 If box 1c is checked, enter State abbreviation . . . . . . . . . . . . . ▶

Part VII Miscellaneous 1 Arbitrage questions:

a If there is a reserve or sinking fund that is expected to repay the issue at maturity, check box . . . . . . . . . ▶

b If 1a is checked and the reserve or sinking fund is funded in equal periodic installments, check box . . . . . . . ▶ c If either the funding of the reserve or sinking fund is expected to result in an amount greater than the amount necessary

to repay the issue; or, if the yield on such fund is greater than the permitted sinking fund yield from line 6, Part III, check box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

d If the issuer established written procedures to monitor the requirements of section 148 with respect to these bonds, check box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

2 If all federal, state, and local requirements governing conflicts of interest are satisfied with respect to this issue, check box . . ▶

3 If the entitlements to credits with respect to this bond issue are expected to be stripped, check box . . . . . . . ▶ 4 If the issuer established written procedures to ensure that all nonqualified bonds at the end of the applicable period are

redeemed within 90 days, check box . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

5 Other: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

Signature and Consent

Under penalties of perjury, I declare that I have examined this return, and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. I further declare that I consent to the IRS's disclosure of the issuer's return information, as necessary to process this return, to the person(s) that I have authorized above.

▲Signature of issuer's authorized representative Date

▲


Paid Preparer’s Use Only

Preparer’s signature

▲

Date Check if self- employed


Firm’s name (or yours if self-employed), address, and ZIP code

▲

EIN

Phone no.

Part VIII Consent to Disclosure of Certain Information from this Return1 Does the issuer give the IRS consent to publish, through a website or in a publication, its name and address, employer

identification number, name and description of bond issue, date of issuance, CUSIP number, issue price, final maturity date, stated redemption price at maturity, applicable credit rate, and maximum term, to assist in the proper reporting of interest, tax credits, or other benefits under IRC section 6049 and Regulations thereunder . . . . . . . . . . . . . ▶ Yes No

Under penalties of perjury, I declare that I am an officer of the above named issuer and that I am authorized to give consent on behalf of the above named issuer for the IRS to publish the items of information described in line 1 of Part VIII of this form to assist in the reporting obligations under IRC section 6049.

Sign Here

▲

Signature Date

▲


Form 8038-TC (6-2010)


Form 8038-TC (6-2010) Page 3 Issuer's name: Issuer's employer identification number (EIN):

Schedule ASchedule for New Clean Renewable Energy Bonds (New CREBs)

▶ Under Internal Revenue Code sections 54A and 54C


Tax Credit Bond Code

102

Part I Issuer Questions Yes No1 Is the issuer a public power provider? . . . . . . . . . . . . . . . . . . . . 12 Is the issuer a cooperative electric company? . . . . . . . . . . . . . . . . . . 23 Is the issuer a governmental body? . . . . . . . . . . . . . . . . . . . . . 34 Is the issuer a clean renewable energy bond lender? . . . . . . . . . . . . . . . . 45 Is the issuer a not-for-profit electric utility which has received a loan/loan guarantee under the Rural

Electrification Act? . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6 Have proceeds been used to acquire existing facilities? (See instructions.) . . . . . . . . 6

7 Have proceeds been used to refinance existing facilities? (See instructions.) . . . . . . . . 78 Is the issue date of the issue on or before the date that is 3 years after the volume cap allocation

date? (See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . 89 9Has the issuer designated these bonds as New CREBs for purposes of section 54C? . . . . .

Part II Amount1 1(For IRS Use Only) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part III List of Qualified Renewable Energy FacilitiesList the type of qualified renewable energy facilities (see instructions) to be financed by the bonds, the location, the owner of such facility, the owner's EIN, and the amount of available project proceeds to be used for that facility. (If more than one, attach schedule.)Type of Facility:

Location of Facility:

Owner's Name:

Owner's EIN:

Amount of Available Project Proceeds $:

Schedule BSchedule for Qualified Energy Conservation Bonds (QECBs)

▶ Under Internal Revenue Code sections 54A and 54D



103

Part I Issuer and Project Questions Yes No1 Has the issuer designated these bonds as QECBs for purposes of section 54D? . . . . . . 12 Has the allocation been reallocated from a large local government to a State? . . . . . . . 23 Is the issuer a large local government? . . . . . . . . . . . . . . . . . . . . 34 Is the issuer an Indian tribal government? . . . . . . . . . . . . . . . . . . . 45 Are all proceeds to be used within the jurisdiction of the issuer? . . . . . . . . . . . . 5

6 If the issuer issued the bonds based on a volume cap allocation received by another authorizedentity (that allocated volume cap to the issue), check "Yes." If not, check "No." Provide the name ofsuch authorized entity. Attach schedule if more than one entity's volume cap is used (See instructions.) 6

Form 8038-TC (6-2010)

Part II Amount1 (For IRS Use Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Part III List of Conservation Purposes, Location of the Facilities, Amount of Proceeds Used for the Purpose, Private Activity User, and Private User's EIN.

1 List the type of qualified conservation purpose described under section 54D(f) financed with the proceeds of the bonds, thelocation of the facility financed with the proceeds of the bond, and the amount of available project proceeds to be used for thequalified conservation purpose. If the bonds are private activity bonds, provide the name and EIN of all private users. (If theissuer is issuing bonds for more than one purpose or facility attach schedule.) Type of qualified conservation purpose:Location of facility financed with bond proceeds:Amount of proceeds to be used for this purpose $: Are the bonds private activity bonds? . . . . . . . . . . . . . . . . . . . . . . ▶ Yes NoIf “Yes,” provide the name and EIN of each private user



Schedule CSchedule for Qualified Zone Academy Bonds (QZABs)

▶ Under Internal Revenue Code sections 54A and 54E



104

Part I Academy and Issuer Information Yes No1 Is the school located in an empowerment zone? . . . . . . . . . . . . . . . . . 12 Is the school located in an enterprise community? . . . . . . . . . . . . . . . . 23 Is it expected that at least 35% of students attending the school or program will be eligible for free

or reduced-cost lunches under the school lunch program established by the National School Lunch Act? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Was the comprehensive educational plan of the school or program approved by the eligible local education agency? . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Is a carryover of unused limitation being used for this issue? If “Yes,” enter the year in which the limitation arose. (See instructions.) ▶ 5

6 Are the bonds issued by a state or local government within the jurisdiction of which the academy is located? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Does the issuer have written commitments from private business entities to make qualified private business contributions having a present value of not less than 10% of the proceeds of this issue? 7

8 Was the bond issuance approved in writing by the eligible local education agency? . . . . . 89 Have these bonds been designated by the issuer as QZABs for purposes of section 54E? . . . 9

10 Enter the name of the eligible local education agency: 10Part II Description of the Private Business Contribution

(Enter the value of the amount of contribution in each type)Amount

1 Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Technical assistance . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Services of donor's employees as volunteers . . . . . . . . . . . . . . . . . . 34 Opportunities for students outside of the academy . . . . . . . . . . . . . . . . 45 Other: . . . . . . . . . . . . . . . 5

Part III Private Business Contributor Information (Attach a schedule if more than five donors)1a Enter the name of the first donor:

b Enter the EIN of the first donor:

2a Enter the name of the second donor:b Enter the EIN of the second donor:

3a Enter the name of the third donor:b Enter the EIN of the third donor:

4a Enter the name of the fourth donor:b Enter the EIN of the fourth donor:

5a Enter the name of the fifth donor:b Enter the EIN of the fifth donor:

Form 8038-TC (6-2010)



Schedule DSchedule for Qualified School Construction Bonds (QSCBs)

▶ Under Internal Revenue Code sections 54A and 54F



105

Part I Use of Proceeds Yes No1 Are the proceeds to be used for an Indian school? (See instructions.) . . . . . . . . . . 12 Are all proceeds to be used within the jurisdiction of the issuer? . . . . . . . . . . . . 23 Have these bonds been designated as QSCBs by the issuer for purposes of section 54F? . . . 34 Are the proceeds of the issue to be spent on costs of acquisition of furniture or equipment? If the

answer is “No,” skip line 5 . . . . . . . . . . . . . . . . . . . . . . . . 45 Is such furniture or equipment to be used in portions of the public school facility being constructed,

rehabilitated, or repaired with the proceeds of the issue? . . . . . . . . . . . . . . 56 Are the proceeds of the issue to be spent on the costs of land acquisition? If the answer is “No,”

skip line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Are proceeds of the issue also to be spent on the costs of construction of a public school facility on

such land? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Part II Amount

1 (For IRS Use Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Part III Issuer Information (Does not apply to issuers that are Indian tribal governments.)

1 If the issuer of the bonds is not the local educational agency in the jurisdiction of which the public school facility is located, please provide the name of such local educational agency. Attach schedule if more than one. (See instructions.)

2 If the issuer issued the bonds based on a volume cap allocation received by another authorized entity (that allocated volume cap to the issue), provide the name of such authorized entity. Attach schedule if more than one entity's volume cap is used. (See instructions.)

Form 8038-TC (6-2010)

313International Special Studies Programs

Form 1042-SDepartment of the Treasury Internal Revenue Service

Foreign Person’s U.S. Source Income Subject to Withholding 2010

AMENDED PRO-RATA BASIS REPORTING

OMB No. 1545-0096

Copy A for Internal Revenue Service

1 Income code

2 Gross income 3 Withholding allowances

4 Net income 5 Tax rate.

6 Exemption cod

7 Federal tax withheld

8 Withholding by other agents

9 Total withholding credit

10 Amount repaid to recipient

11 Withholding agent’s EIN ▶

EIN QI-EIN

12a WITHHOLDING AGENT’S name

12b Address (number and street)

12c Additional address line (room or suite no.)

12d City or town, province or state, country, ZIP or foreign postal code

13a RECIPIENT’S name 13b Recipient code

13c Address (number and street)

13d Additional address line (room or suite no.)

13e City or town, province or state, country, ZIP or foreign postal code

14 Recipient’s U.S. TIN, if any ▶

SSN or ITIN EIN QI-EIN

15 Recipient’s foreign tax identifying number, if any 16 Country code

17 NQI’s/FLOW-THROUGH ENTITY’S name 18 Country code

19a NQI’s/Entity’s address (number and street)

19b Additional address line (room or suite no.)

19c City or town, province or state, country, ZIP or foreign postal code

20 NQI’s/Entity’s U.S. TIN, if any ▶

21 PAYER’S name and TIN (if different from withholding agent’s)

22 Recipient account number (optional)

23 State income tax withheld 24 Payer’s state tax no. 25 Name of state

For Privacy Act and Paperwork Reduction Act Notice, see page 17 of the separate instructions. Cat. No. 11386R

X

XX

X

X

X

314 International Special Studies Programs

Explanation of CodesBox 1. Income code.

Code Types of Income

Inte

rest

01 Interest paid by U.S. obligors—general

02 Interest paid on real property mortgages

03 Interest paid to controlling foreign corporations

04 Interest paid by foreign corporations

05 Interest on tax-free covenant bonds

29 Deposit interest

30 Original issue discount (OID)

31 Short-term OID

33 Substitute payment—interest

Div

iden

d

06 Dividends paid by U.S. corporations—general

07 Dividends qualifying for direct dividend rate

08 Dividends paid by foreign corporations

34 Substitute payment—dividends

40 Other U.S. source dividend equivalents under IRC section 871(m) (formerly 871(l))

Oth

er

09 Capital gains

10 Industrial royalties

11 Motion picture or television copyright royalties

12 Other royalties (for example, copyright, recording, publishing)

Oth

er13 Real property income and natural resources royalties

14 Pensions, annuities, alimony, and/or insurance premiums

15 Scholarship or fellowship grants

16 Compensation for independent personal services1

17 Compensation for dependent personal services1

18 Compensation for teaching1

19 Compensation during studying and training1

20 Earnings as an artist or athlete2

24 Real estate investment trust (REIT) distributions of capital gains

25 Trust distributions subject to IRC section 1445

26 Unsevered growing crops and timber distributions by a trust subject to IRC section 1445

27 Publicly traded partnership distributions subject to IRC section 1446

28 Gambling winnings6

32 Notional principal contract income3

35 Substitute payment—other

36 Capital gains distributions

37 Return of capital

38 Eligible deferred compensation items subject to IRC section 877A(d)(1)

39 Distributions from a nongrantor trust subject to IRC section 877A(f)(1)

50 Other income

See back of Copy D for additional codes.

1 If compensation that otherwise would be covered under Income Codes 16–19 is directly attributable to the recipient’s occupation as an artist or athlete, use Income Code 20 instead.2 If Income Code 20 is used, Recipient Code 09 (artist or athlete) should be used instead of Recipient Code 01 (individual), 02 (corporation), or 03 (partnership other than withholding foreign partnership).3 Use appropriate Interest Income Code for embedded interest in a notional principal contract.4 Non-U.S. source income received by a nonresident alien is not subject to U.S. tax. Use Exemption Code 03 when entering an amount for information reporting purposes only.5 May be used only by a qualified intermediary.6 Subject to 30% withholding rate unless the recipient is from one of the treaty countries listed under Gambling winnings (Income Code 28) in Pub. 515.


Explanation of Codes (continued)Box 6. Exemption code (applies if the tax rate entered in box 5 is 00.00).

Code Authority for Exemption

01 Income effectively connected with a U.S. trade or business

02 Exempt under an Internal Revenue Code section (income other than portfolio interest)

03 Income is not from U.S. sources4

04 Exempt under tax treaty

05 Portfolio interest exempt under an Internal Revenue Code section

06 Qualified intermediary that assumes primary withholding responsibility

07 Withholding foreign partnership or withholding foreign trust

08 U.S. branch treated as a U.S. person

09 Qualified intermediary represents income is exempt

10 Qualified securities lender that assumes primary withholding responsibility for substitute dividends

Box 13b. Recipient code.

Code Type of Recipient

01 Individual2

02 Corporation2

03 Partnership other than withholding foreign partnership2

Box 13b. Recipient code (continued).

04 Withholding foreign partnership or withholding foreign trust

05 Trust

06 Government or international organization

07 Tax-exempt organization (IRC section 501(a))

08 Private foundation

09 Artist or athlete2

10 Estate

11 U.S. branch treated as U.S. person

12 Qualified intermediary

13 Private arrangement intermediary withholding rate pool—general5

14 Private arrangement intermediary withholding rate pool— exempt organizations5

15 Qualified intermediary withholding rate pool—general5

16 Qualified intermediary withholding rate pool—exempt organizations5

17 Authorized foreign agent

18 Public pension fund

20 Unknown recipient

21 Qualified securities lender—qualified intermediary

22 Qualified securities lender—other

1 If compensation that otherwise would be covered under Income Codes 16–19 is directly attributable to the recipient’s occupation as an artist or athlete, use Income Code 20 instead.2 If Income Code 20 is used, Recipient Code 09 (artist or athlete) should be used instead of Recipient Code 01 (individual), 02 (corporation), or 03 (partnership other than withholding foreign partnership).3 Use appropriate Interest Income Code for embedded interest in a notional principal contract.4 Non-U.S. source income received by a nonresident alien is not subject to U.S. tax. Use Exemption Code 03 when entering an amount for information reporting purposes only.5 May be used only by a qualified intermediary.6 Subject to 30% withholding rate unless the recipient is from one of the treaty countries listed under Gambling winnings (Income Code 28) in Pub. 515.

X X


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f Par

t III

) .

..

..

..

..

..

..

..

Par

t III

—S

umm

ary

of

Sep

arat

e C

red

its

(Ent

er a

mou

nts

from

Par

t II,

line

12

for

each

ap

plic

able

cat

egor

y of

inco

me.

Do

no

t in

clud

e ta

xes

pai

d t

o sa

nctio

ned c

ount

ries.

)1

Cre

dit

for

taxe

s on

pas

sive

cat

egor

y in

com

e .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.2

Cre

dit

for

taxe

s on

gen

eral

cat

egor

y in

com

e .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.3

Cre

dit

for

taxe

s on

inco

me

re-s

ourc

ed b

y tr

eaty

(com

bin

e al

l suc

h cr

edits

on

this

line

) .

..

..

..

..

..

..

..

.4

Tota

l (ad

d li

nes

1 th

roug

h 3)

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

5R

educ

tion

in c

red

it fo

r in

tern

atio

nal b

oyco

tt o

per

atio

ns (s

ee in

stru

ctio

ns)

..

..

..

..

..

..

..

..

..

..

..

..

..

.6

To

tal f

ore

ign

tax

cred

it (s

ubtr

act

line

5 fr

om li

ne 4

). E

nter

her

e an

d o

n th

e ap

pro

pria

te li

ne o

f the

cor

por

atio

n’s

tax

retu

rn

..

..

..

..

..

Form

111

8 (R

ev. 1

2-20

09)


Form

111

8 (R

ev. 1

2-20

09)

Pag

e 6

Sch

edul

e F

Gro

ss In

com

e an

d D

efin

itel

y A

lloca

ble

Ded

ucti

ons

fo

r Fo

reig

n B

ranc

hes

1. F

orei

gn C

ount

ry o

r U

.S. P

osse

ssio

n (E

nter

tw

o-le

tter

cod

e fr

om S

ched

ule

A, c

olum

n 1.

U

se a

sep

arat

e lin

e fo

r ea

ch.)

2. G

ross

Inco

me

3. D

efin

itely

Allo

cab

le

Ded

uctio

ns

A B C D E F

To

tals

(ad

d li

nes

A t

hrou

gh F

)* �

* N

ote

: Th

e S

ched

ule

F to

tals

are

not

car

ried

over

to a

ny o

ther

For

m 1

118

Sch

edul

e. (T

hese

tota

ls w

ere

alre

ady

incl

uded

in

Sch

edul

e A

.) H

owev

er, t

he IR

S r

equi

res

the

corp

orat

ion

to c

ompl

ete

Sch

edul

e F

unde

r th

e au

thor

ity o

f sec

tion

905(

b).

Sch

edul

e G

Red

ucti

ons

of

Tax

es P

aid

, Acc

rued

, or

Dee

med

Pai

d

AR

educ

tion

of

Taxe

s U

nder

S

ectio

n 90

1(e)

—A

ttac

h se

par

ate

sche

dul

e

BR

educ

tion

of

Fore

ign

Oil

and

G

as

Taxe

s—E

nter

am

ount

from

Sch

edul

e I,

Par

t II,

line

6

CR

educ

tion

of T

axes

Due

to In

tern

atio

nal B

oyco

tt Pr

ovis

ions

—

Ente

r app

ropr

iate

por

tion

of S

ched

ule

C (F

orm

571

3), l

ine

2b.

Impo

rtan

t: En

ter o

nly

“spe

cific

ally

attr

ibut

able

taxe

s” h

ere.

DR

educ

tion

of

Taxe

s fo

r S

ectio

n 60

38(c

) P

enal

ty—

A

ttac

h se

par

ate

sche

dul

e

EO

ther

Red

uctio

ns o

f Tax

es—

Att

ach

sche

dul

e(s)

To

tal

(ad

d l

ines

A t

hrou

gh E

). E

nter

her

e an

d o

n S

ched

ule

B, P

art

II, li

ne 3

.

..

..

..

..

..

..

. �

Form

111

8 (R

ev. 1

2-20

09)


Form

111

8 (R

ev. 1

2-20

09)

Pag

e 7

Sch

edul

e H

Ap

po

rtio

nmen

t o

f D

educ

tio

ns N

ot

Def

init

ely

Allo

cab

le (c

omp

lete

onl

y on

ce)

Par

t I—

Res

earc

h an

d D

evel

op

men

t D

educ

tio

ns

(a) S

ales

Met

hod

Pro

duc

t lin

e #1

(SIC

Cod

e:) *

Pro

duc

t lin

e #2

(SIC

Cod

e:) *

(i) G

ross

Sal

es(ii

) R&

D D

educ

tions

(iii)

Gro

ss S

ales

(iv) R

&D

D

educ

tions

(v) T

otal

R&

D

Ded

uctio

ns U

nder

S

ales

Met

hod

(add

co

lum

ns (i

i) an

d (iv

))

(b) G

ross

Inco

me

Met

hod—

Che

ck m

etho

d us

ed:

(See

in

stru

ctio

ns.)

Op

tion

1O

ptio

n 2

(vi)

Gro

ss In

com

e(v

ii) T

otal

R&

D

Ded

uctio

ns U

nder

G

ross

Inco

me

Met

hod

(c) T

otal

R&

D

Ded

uctio

ns N

ot

Def

inite

ly A

lloca

ble

(e

nter

all

amou

nts

from

col

umn

(a)(v

) or

all

amou

nts

from

co

lum

n (b

)(vii)

)1

Tota

ls (s

ee in

stru

ctio

ns)

2To

tal t

o b

e ap

por

tione

d3

Ap

por

tionm

ent

amon

g st

atut

ory

grou

pin

gs:

aG

ener

al c

ateg

ory

inco

me

bP

assi

ve c

ateg

ory

inco

me

cS

ectio

n 90

1(j)

inco

me*

dIn

com

e re

-sou

rced

by

trea

ty*

4To

tal f

orei

gn (a

dd li

nes

3a th

roug

h 3d

)*

Imp

ort

ant:

See

Com

pu

ter-

Gen

erat

ed S

ched

ule

H in

inst

ruct

ions

.Fo

rm 1

118

(Rev

. 12-

2009

)


Form

111

8 (R

ev. 1

2-20

09)

Pag

e 8

Sch

edul

e H

Ap

po

rtio

nmen

t o

f D

educ

tio

ns N

ot

Def

init

ely

Allo

cab

le (c

ontin

ued

)P

art

II—In

tere

st D

educ

tio

ns, A

ll O

ther

Ded

ucti

ons

, and

To

tal D

educ

tio

ns(a

) A

vera

ge V

alue

of A

sset

s—C

heck

met

hod

use

d:

Fair

mar

ket

valu

eTa

x b

ook

valu

e

Alte

rnat

ive

tax

boo

k va

lue

(i) N

onfin

anci

al

Cor

por

atio

ns(ii

) Fin

anci

al C

orp

orat

ions

(b) I

nter

est

Ded

uctio

ns

(iii)

Non

finan

cial

C

orp

orat

ions

(iv) F

inan

cial

C

orp

orat

ions

(c)

All

Oth

er

Ded

uctio

ns N

ot

Def

inite

ly A

lloca

ble

(d)

Tota

ls (a

dd

the

co

rres

pon

din

g am

ount

s fr

om

colu

mn

(c),

Par

t I;

colu

mns

(b)(i

ii) a

nd

(b)(i

v), P

art

II; a

nd

colu

mn

(c),

Par

t II)

. E

nter

eac

h am

ount

fr

om li

nes

3a

thro

ugh

3d b

elow

in

col

umn

10 o

f the

co

rres

pon

din

g S

ched

ule

A.

1aTo

tals

(see

inst

ruct

ions

)b

Am

ount

s sp

ecifi

cally

allo

cab

le u

nder

Tem

p. R

egs.

1.

861-

10T(

e)

cO

ther

spe

cific

allo

catio

ns u

nder

Tem

p. R

egs.

1.8

61-1

0T

dA

sset

s ex

clud

ed fr

om a

pp

ortio

nmen

t fo

rmul

a2

Tota

l to

be

app

ortio

ned

(sub

trac

t th

e su

m o

f lin

es 1

b,

1c, a

nd 1

d fr

om li

ne 1

a)3

Ap

por

tionm

ent

amon

g st

atut

ory

grou

pin

gs:

aG

ener

al c

ateg

ory

inco

me

bP

assi

ve c

ateg

ory

inco

me

cS

ectio

n 90

1(j)

inco

me*

dIn

com

e re

-sou

rced

by

trea

ty*

Tota

l for

eign

(ad

d li

nes

3a t

hrou

gh 3

d)

* Im

po

rtan

t: S

ee C

omp

ute

r-G

ener

ated

Sch

edu

le H

in in

stru

ctio

ns.

Form

111

8 (R

ev. 1

2-20

09)


SC

HE

DU

LE I

(Fo

rm 1

118)

(Rev

. Dec

emb

er 2

009)

Dep

artm

ent o

f the

Tre

asur

y

Inte

rnal

Rev

enue

Ser

vice

Red

ucti

on o

f Fo

reig

n O

il an

d G

as T

axes

� A

ttac

h to

Fo

rm 1

118

For

cale

ndar

yea

r 20

, or

othe

r ta

x ye

ar b

egin

ning

, 20

, and

end

ing

, 20

OM

B N

o. 1

545-

0122

Nam

e of

cor

por

atio

nE

mp

loye

r id

enti

ficat

ion

num

ber

Rep

ort

all a

mou

nts

in U

.S. d

olla

rs. C

omp

lete

a s

epar

ate

Sch

edul

e I f

or e

ach

ap

plic

able

cat

egor

y of

inco

me.

Par

t I

Co

mb

ined

Fo

reig

n O

il an

d G

as In

com

e an

d T

axes

1. N

ame

of fo

reig

n co

untr

y

(Use

a s

epar

ate

line

for

ea

ch c

ount

ry.)

Gro

ss F

ore

ign

Oil

and

Gas

Inco

me

Fro

m S

our

ces

Out

sid

e th

e U

nite

d S

tate

s an

d it

s P

oss

essi

ons

(See

inst

ruct

ions

.)

2. G

ross

fore

ign

oil a

nd

gas

extr

actio

n in

com

e3.

Gro

ss fo

reig

n oi

l rel

ated

in

com

e4.

Cer

tain

div

iden

ds

from

fo

reig

n co

rpor

atio

ns

5. C

onst

ruct

ive

d

istr

ibut

ions

und

er

sect

ion

951(

a)6.

Oth

er7.

Tot

al (a

dd

col

umns

2

thro

ugh

6)

A B C D E F

To

tals

(ad

d li

nes

A t

hrou

gh F

) D

educ

tio

ns

8. D

efin

itely

allo

cab

le

ded

uctio

ns9.

Rat

able

par

t of

ded

uctio

ns

not

def

inite

ly a

lloca

ble

10. T

otal

(ad

d c

olum

ns 8

an

d 9

)

11. T

axab

le in

com

e

(col

umn

7 m

inus

co

lum

n 10

)

Fore

ign

Oil

and

Gas

Tax

es (a

ttac

h sc

hed

ule)

12. P

aid

or

accr

ued

13. D

eem

ed p

aid

14. T

otal

(ad

d c

olum

ns 1

2

and

13)

A B C D E F

To

tals

For

Pap

erw

ork

Red

ucti

on

Act

No

tice

, see

the

Inst

ruct

ions

fo

r Fo

rm 1

118.

Cat

. No.

102

37L

Sch

edul

e I (

Form

111

8) (R

ev. 1

2-20

09)


Schedule I (Form 1118) (Rev. 12-2009) Page 2

Part II Reduction Under Section 907(a)

1 Combined foreign oil and gas income. (See the instructions for Line 1 below.) . . . . . . .

2 Multiply line 1 by the highest rate of tax under section 11(b). (See Line 2 below.) . . . . . .

3 Total taxes (from Part I, column 14, “Totals” line) . . . . . . . . . . . . . . . . .

4 Carryover or carryback of disallowed credits. (See section 907(f)—attach schedule.) . . . . .

5 Total taxes before reduction (add line 3 and line 4) . . . . . . . . . . . . . . . .

6 Reduction (subtract line 2 from line 5; if zero or less, enter -0-). Enter here and on Schedule G, line B of the corresponding Form 1118 . . . . . . . . . . . . . . . . . . . .


Who Must FileIf the corporation claims a credit for any income taxes paid, accrued, or deemed paid during the tax year on combined foreign oil and gas income, the amount of such taxes eligible for credit may be reduced. See section 907(a) and Regulations section 1.907(a)-1 for details.

Complete Schedule I for each applicable category of income.

Method of ReportingReport all amounts in U.S. dollars. If it is necessary to convert from foreign currency, attach a statement explaining how the rate was determined.

Specific Instructions

Part ISee section 907(c) and underlying regulations for rules on the income to include in Part I.

Note. Do not include any dividend or interest income that is passive income. See the instructions for Form 1118 for the definition of passive income.

Column 2. Enter gross income from sources outside the United States and its possessions from the following:

● The extraction (by the corporation or any other person) of minerals from oil or gas wells located outside the United States and its possessions.

● The sale or exchange of assets used in the trade or business of extracting minerals from oil or gas wells located outside the United States and its possessions.

See section 907(c)(1).

Column 3. Enter gross income from sources outside the United States and its possessions from the following:

● The processing of minerals extracted (by the corporation or any other person) of minerals from oil or gas wells (located outside the United States and its possessions) into their primary products.

● The transportation of such minerals or primary products.

● The distribution or sale of such minerals or primary products.

● The disposition of assets used in the trade or business described in the three previous bulleted items.

● The performance of any other related service.


Column 4. Enter dividends (including section 78 gross-up) from a foreign corporation on which taxes are deemed paid

under section 902 only if the dividends are paid out of foreign oil and gas extraction income or foreign oil related income of the distributing corporation and are not passive income. Dividends from foreign corporations for which the corporation is not entitled to compute a deemed paid credit are passive income and are not included in Part I.

Column 5. Enter amounts taxable under section 951(a) (including section 78 gross-up) that are attributable to the controlled foreign corporation’s combined foreign oil and gas income.

Column 6. Include the corporation’s distributive share of partnership combined foreign oil and gas income. Also include in column 6 interest income paid by a foreign corporation on which taxes are deemed paid under section 902, to the extent it is paid out of foreign oil-related income. However, do not include interest income paid by a foreign subsidiary out of foreign oil and gas extraction income of the payor, even if it is not passive income.


Column 11. For each country, subtract column 10 from column 7 and enter the result in column 11. When totaling the column 11 amounts, note that a taxable loss from a foreign country offsets taxable income from other countries.

Columns 12 and 13. Attach a schedule to show how the foreign taxes paid, accrued, or deemed paid with respect to combined foreign oil and gas income were figured.

Part IILine 1. Enter the total from Part I, column 11, minus any recapture described in section 907(c)(4).

Line 2. At the time this schedule went to print, the highest rate of tax specified under section 11(b) was 35%.


Schedule J (Form 1118)

(Rev. January 2009)


Adjustments to Separate Limitation Income (Loss) Categories for Determining Numerators of Limitation Fractions, Year-End

Recharacterization Balances, and Overall Foreign and Domestic Loss Account Balances

For calendar year 20 , or other tax year beginning , 20 , and ending , 20

� Attach to Form 1118. For Paperwork Reduction Act Notice, see the Instructions for Form 1118.

OMB No. 1545-0122

Name of corporation Employer identification number

Part I Adjustments to Separate Limitation Income or (Losses) in Determining Numerators of Limitation Fractions (see instructions)

(i) General category income

(ii) Passive category income

(iii) Other income*

(iv) U.S. income

1 Income or (loss) before adjustments 2 Allocation of separate limitation losses: a General category income ( ) ( )

b Passive category income ( ) ( )

c Other income* ( ) ( )

3 Subtotal— Combine lines 1 through 2c. Allocation of overall foreign losses ( )

5 Allocation of domestic losses ( ) ( ) ( )

6 Subtotal— Combine lines 3 through 5. 7 Recapture of overall foreign losses ( ) ( ) ( )

8 Subtotal— Combine lines 6 and 7. 9 Recharacterization of separate limitation income: a General category income ( )

b Passive category income ( )

c Other income* ( )

10 Recapture of overall domestic losses ( )

11 Numerator of Limitation Fraction— Combine lines 8 through 10. Enter each result here and on Schedule B, Part II, line7, of corresponding Form 1118.

Part II Year-End Balances of Future Separate Limitation Income That Must Be Recharacterized (section 904(f)(5)(C)) a General category income b Passive category incomec Other income*

Part III Overall Foreign Loss Account Balances (section 904(f)(1)) Complete for each separate limitation income category.

1 Beginning balance 2 Current year additions3 Current year reductions (other than

recapture) ( ) ( ) ( )Current year recapture (from Part I, line 7) ( ) ( ) ( )

5 Ending balance—Combine lines 1 through 4.

Part IV Overall Domestic Loss Account Balances (section 904(g)(1)) 1 Beginning balance 2 Current year additions3 Current year reductions (other than

recapture) ( ) ( ) ( )4 Subtotal—Combine lines 1 through 3.5 Current year recapture (from Part I, line

10) 6 Ending balance—Subtract line 5

from line 4.

* Important: See Computer-Generated Schedule J in instructions. Cat. No. 10309U Schedule J (Form 1118) (Rev. 1-2009)

4

4


Fore

ign

Tax

Car

ryov

er R

econ

cilia

tion

Sch

edul

e

For

cale

ndar

yea

r20

, or

oth

er t

ax y

ear

beg

inni

ng,

20,

and

end

ing

, 20

.

OM

B N

o. 1

545-

0122

Nam

e of

cor

por

atio

n

Em

plo

yer

iden

tific

atio

n nu

mb

er

1

(i)

10th

P

rece

ding

Ta

x Y

ear

For

Pap

erw

ork

Red

ucti

on

Act

No

tice

, se

e th

e in

stru

ctio

ns f

or

Form

111

8.

Cat

. N

o. 5

1904

R

Sch

edul

e K

(Fo

rm 1

118)

(12

-200

9)

�S

ee s

epar

ate

inst

ruct

ions

. �

Att

ach

to F

orm

111

8.

(Dec

emb

er 2

009)

SC

HE

DU

LE K

(Fo

rm 1

118)

Dep

artm

ent

of t

he T

reas

ury

Inte

rnal

Rev

enue

Ser

vice

Use

a s

epar

ate

Sch

edul

e K

(Fo

rm 1

118)

for

eac

h ca

tego

ry o

f in

com

e lis

ted

bel

ow.

Che

ck o

nly

one

box

on

each

sch

edul

e.

Fore

ign

tax

carr

yove

r fr

om t

he p

rior

tax

year

(en

ter

the

amou

nt f

rom

line

6 o

fth

e w

orks

heet

in t

he in

stru

ctio

ns)

(ii)

9th

Pre

cedi

ng

Tax

Yea

r

(iii)

8th

Pre

cedi

ng

Tax

Yea

r

(iv)

7th

Pre

cedi

ng

Tax

Yea

r

(v)

6th

Pre

cedi

ng

Tax

Yea

r

(vi)

5th

Pre

cedi

ng

Tax

Yea

r

2 A

dju

stm

ents

to

line

1 (e

nter

des

crip

tion—

see

inst

ruct

ions

):

a b c d 3 A

dju

sted

for

eign

tax

car

ryov

er f

rom

prio

r ta

x ye

ar (

com

bin

e lin

es 1

and

2).

4

Fore

ign

tax

carr

yove

r ex

pire

d u

nuse

din

cur

rent

tax

yea

r (e

nter

as

a ne

gativ

enu

mb

er)

5

Fore

ign

tax

carr

yove

r us

ed in

cur

rent

tax

year

(en

ter

as a

neg

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OMB No. 1545-0938 Interest Charge Domestic InternationalSales Corporation Return

1120-IC-DISC

Form


(Please type or print.)

For calendar year 20_____, or tax year beginning , 20_____, and ending , 20_____. Date of IC-DISC election A C Employer identification number Name

D Date incorporated Number, street, and room or suite no. (or P.O. box if mail is not delivered to street address)

Business activity code no.

B E Total assets (see instructions)


$

F Check applicable box(es): No Yes G(1)

Did any corporation, individual, partnership, trust, or estate own, directly or indirectly, 50% or more of theIC-DISC’s voting stock at the end of the IC-DISC’s tax year? (See section 267(c) for rules of attribution.)

If “Yes,” complete the following schedule. (If a foreign owner, see instructions.)

Votingstock

owned

Foreignowner

Total assets(corporations only)

Identifyingnumber

Address Name

No Yes

Enter the following for any corporation listed in G(1) that will report the IC-DISC’s income: (2) Tax year of first corporation IRS Service Center where return will be filed

Tax year of second corporation IRS Service Center where return will be filed

Check the appropriate box(es) to indicate any intercompany pricing rules that were applied to 25% or more of grossincome (line 1 below):

H(1)

Check here if the marginal costing rules under section 994(b)(2) were applied in figuring the combined taxable incomefor any transactions.

(2)

All Computations Must Reflect Intercompany Pricing Rules If Used (Section 994)See separate Schedule P (Form 1120-IC-DISC). Taxable Income

1 Gross income. Enter amount from Schedule B, line 4, column (e) 1 2 Cost of goods sold from Schedule A, line 8 2 3 Total income. Subtract line 2 from line 1 3 4 Deductions. Enter amount from Schedule E, line 3 4

5 Taxable income before net operating loss deduction and dividends-received deduction. Subtract line 4 from line 3

5

6a Net operating loss deduction (attach schedule) 6a 6b Dividends-received deduction from Schedule C, line 9 b

6c Add lines 6a and 6b c 7 Taxable income. Subtract line 6c from line 5 7

Refundable credit for federal tax paid on fuels (attach Form 4136) 8 8

Form 1120-IC-DISC (Rev. 12-2008)

For Privacy Act and Paperwork Reduction Act Notice, see instructions.


Cat. No. 11473P

50-50 combined taxable income method

%

%

(See instructions.)

4% gross receipts method

Section 482 method (“arm’s length pricing”)

(1)

Initial return

(2)

Final return

(4)

Address change

(5)

Amended return

(3)

Name change

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Sign

Here Title

Date







EIN Phone no. ( )

� �

�

(Rev. December 2008)


Page 2


Cost of Goods Sold (see instructions) If the intercompany pricing rules of section 994 are used, reflect actual purchases from a related supplier at

the transfer price determined under such rules. See separate Schedule P (Form 1120-IC-DISC). 1 Inventory at beginning of the year 1

2 Purchases 2 3 Cost of labor 3 4 4 Additional section 263A costs (attach schedule) 5 Other costs (attach schedule) 6 Total. Add lines 1 through 5

5

7 Inventory at end of the year 6

8 Cost of goods sold. Subtract line 7 from line 6. Enter here and on line 2, page 1 7

Check all methods used for valuing closing inventory: 8

Cost as described in Regulations section 1.471-3 Lower of cost or market as described in Regulations section 1.471-4 (ii)

(i)

(iii) Other (Specify method used and attach explanation.) �

Check if there was a writedown of “subnormal” goods as described in Regulations section 1.471-2(c) � b

If the LIFO inventory method was used for this tax year, enter percentage (or amounts) of closing inventory computed under LIFO

d 9d

Was there any change in determining quantities, cost, or valuations between the opening and closing inventory? (If “Yes,” attach explanation.) e Yes No If property is produced or acquired for resale, do the rules of section 263A apply to the corporation? f Yes No

Gross Income (see instructions) (e) Total (add

columns (c) and (d))

Commission sales (d) Otherreceipts

(a) Type of receipts (c) Commission

(b) Gross receipts

Qualified export receipts from sale of export property— 1 To unrelated purchasers: a (i) Direct foreign sales

Foreign sales through a related foreign entity (ii) Persons in the United States (other than an unrelated IC-DISC)

(iii)

An unrelated IC-DISC (iv) To related purchasers: b

Direct foreign sales (i) Persons in the United States (ii)

Total c Other qualified export receipts: 2 Leasing or renting of export property a Services related and subsidiary to a qualified export sale or lease

b

Engineering and architectural services c Export management services d Qualified dividends (Schedule C, line 15) e Interest on producer’s loans f Other interest (attach schedule) g

h Capital gain net income (attach Schedule D (Form 1120))

Net gain or (loss) from Part II, Form 4797(attach Form 4797)

i

Other (attach schedule) j k Total

Nonqualified gross receipts: 3 Ultimate use in United States a Exports subsidized by the U.S. Government

b

Certain direct or indirect sales or leases foruse by the U.S. Government

c

Sales to other IC-DISCs in the samecontrolled group

d

Nonqualified dividends (Schedule C, line 16) e Other (attach schedule) f

g Total 4 Total. Add lines 1c, 2k, 3g, column (e). Enter here and on line 1, page 1

Schedule A

Schedule B

9a

Check if the LIFO inventory method was adopted this tax year for any goods. (If checked, attach Form 970.) � c



Page 3 Form 1120-IC-DISC (Rev. 12-2008)

Dividends and Dividends-Received Deduction (see instructions)

(c) Dividends–receiveddeduction:((a) � (b))

(a) Dividendsreceived

(b) % 1 Dividends from less-than-20%-owned domestic corporations (other than

debt-financed stock)

70 2 Dividends from 20%-or-more-owned domestic corporations (other than

debt-financed stock)

80 see

instructions

Dividends on debt-financed stock of domestic and foreign corporations(section 246A)

3

42 Dividends on certain preferred stock of less-than-20%-owned public utilities

4 48 Dividends on certain preferred stock of 20%-or-more-owned public utilities

5

Dividends from less-than-20%-owned foreign corporations

6 70 Dividends from 20%-or-more-owned foreign corporations

7 80

Dividends from wholly owned foreign subsidiaries (section 245(b))

8 100 Total. Add lines 1 through 8. See instructions for limitation

9

10 Dividends from foreign corporations not included on lines 3, 6, 7, or 8 11 Income from controlled foreign corporations under subpart F

(attach Form(s) 5471) 12 IC-DISC and former DISC dividends not included on lines 1, 2, or 3

(section 246(d)) 13 Other dividends 14 Total dividends. Add lines 1 through 13, column (a)

15 Qualified dividends. Enter here and on Schedule B, line 2e, column (d) Nonqualified dividends. Subtract line 15 from line 14. Enter here and on

Schedule B, line 3e, column (d)

16

Deductions (Before completing, see Limitations on Deductions in the instructions.)

1 Export promotion expenses: Market studies a Advertising b Depreciation (attach Form 4562) c Salaries and wages d Rents e Sales commissions f Warehousing g Freight (excluding insurance) h Compensation of officers i Repairs and maintenance j Pension, profit-sharing, etc., plans k Employee benefit programs l Other (list): m

Total. Add lines 1a through 1m

n Other expenses not deducted on line 1: 2 Bad debts a Taxes and licenses b Interest c Contributions d Freight e Freight insurance f Other (list): g

h Total. Add lines 2a through 2g 3 Total deductions. Add lines 1n and 2h. Enter here and on line 4, page 1

Schedule C

Schedule E

3

1a 1b 1c 1d 1e 1f 1g 1h 1i 1j 1k 1l

1m 1n 2a 2b 2c 2d 2e 2f 2g 2h




Deemed and Actual Distributions and Deferred DISC Income for the Tax Year Part I—Deemed Distributions Under Section 995(b)(1) (see instructions)

Gross interest derived during the tax year from producer’s loans (section 995(b)(1)(A))

1 1 Gain recognized on the sale or exchange of section 995(b)(1)(B) property (attach schedule)

2 2 3 Gain recognized on the sale or exchange of section 995(b)(1)(C) property (attach schedule)

3

50% of taxable income attributable to military property (section 995(b)(1)(D)) (attach schedule)

4 4 5 Taxable income from line 7, Part II, below

5

6 Taxable income of the IC-DISC (from line 7, page 1)

6 7 Add lines 1 through 5

7

8 Subtract line 7 from line 6

8

9 If you have shareholders that are C corporations, enter one-seventeenth of line 8 (.0588235 times line 8)

9

10 International boycott income (see instructions)

10 11 Illegal bribes and other payments

11

Note: Separate computations for lines 12–23 are required for shareholders that are C corporationsand shareholders that are not C corporations. Complete lines 12, 14, 15, 17a, 18, 20, and 22for shareholders that are not C corporations. Complete lines 13, 14, 16, 17b, 19, 21, and 23 forshareholders that are C corporations.

12 Add lines 7, 10, and 11

12 13 Add lines 7, 9, 10, and 11

13

14 Earnings and profits for the tax year (attach schedule)

14 15 Enter the smaller of line 12 or 14

15

16 Enter the smaller of line 13 or 14

16 Foreign investment attributable to producer’s loans (attach schedule):

17 17a For shareholders other than C corporations

a

17b For shareholders that are C corporations

b 18 Add lines 15 and 17a

18

19 Add lines 16 and 17b

19 % Enter percentage of stock owned by shareholders other than C corporations

20 20

21 % Enter percentage of stock owned by shareholders that are C corporations

21 22 Multiply line 18 by line 20 (Allocate to shareholders other than C corporations)

22

Multiply line 19 by line 21 (Allocate to C corporation shareholders)

23 23 24 Total deemed distributions under section 995(b)(1) for all shareholders. Add lines 22 and 23

24

Part II—Section 995(b)(1)(E) Taxable Income (see instructions) 1 Total qualified export receipts (see instructions)

1

$10,000,000 2 Statutory maximum

2 3 Controlled group member’s portion of the statutory maximum

3

4 Enter smaller of (a) 1 or (b) number of days in tax year divided by 365 (or 366) (see instructions)

4 5 Proration. Multiply line 2 or 3, whichever is applicable, by line 4

5

Excess qualified export receipts. Subtract line 5 from line 1. (If line 5 exceeds line 1, enter -0-here and on line 7 below.)

6 6

Taxable income attributable to line 6 receipts. Enter here and on line 5 of Part I above

7 7 Part III—Deemed Distributions Under Section 995(b)(2) (see instructions)

1 Annual installment of distribution attributable to revocation of election in an earlier year

1 2 2 Annual installment of distribution attributable to not qualifying as a DISC or IC-DISC in an earlier year

3 Total deemed distributions under section 995(b)(2). Add lines 1 and 2

3 Part IV—Actual Distributions (see instructions)

1 1 Distributions to meet qualification requirements under section 992(c) (attach computation) 2 2 Other actual distributions

3 3 Total. Add lines 1 and 2 4 Amount on line 3 treated as distributed from:

4a Previously taxed income a 4b Accumulated IC-DISC income (including IC-DISC income of the current year)

b

4c Other earnings and profits c 4d Other d

Part V—Deferred DISC Income Under Section 995(f)(3) (see instructions) 1 1 Accumulated IC-DISC income (for periods after 1984) at end of computation year

2 Distributions-in-excess-of-income for the tax year following the computation year to which line 1 applies

2 3 Deferred DISC income under section 995(f)(3). Subtract line 2 from line 1

3

Schedule J



Page 5


(a) Beginning of tax year (b) End of tax year Balance Sheets per Books Qualified export assets: 1

a Working capital (cash and necessary temporary investments) Funds awaiting investment (cash in U.S. banks in excess of working capital needs) in other qualified export assets

b

c Export-Import Bank obligations d Trade receivables (accounts and notes receivable)

) ( ) ( Less allowance for bad debts

Ass

ets

e Export property (net) (including inventory and qualified property held for lease) f Producer’s loans

Investment in related foreign export corporations g h Depreciable assets

) ( ) ( Less accumulated depreciation i Other (attach schedule)

Nonqualified assets (net) (list): 2 Total assets. Combine lines 1a through 2 3

Accounts payable 4 Other current liabilities (attach schedule) 5 Mortgages, notes, bonds payable in 1 year or more 6 Other liabilities (attach schedule) 7 Capital stock 8 Additional paid-in capital 9 Other earnings and profits 10

Liab

iliti

es a

ndS

hare

hold

ers’

Eq

uity

Previously taxed income (section 996(f)(2)) 11 Accumulated pre-1985 DISC income (see instructions) 12

13 Accumulated IC-DISC income (see instructions) ) ( ) ( Less cost of treasury stock 14

Total liabilities and shareholders’ equity 15 Reconciliation of Income per Books With Income per Return

Net income (loss) per books

1 Income recorded on books this year notincluded on this return (itemize):

6 Excess of capital losses over capital gains

2

Taxable income not recorded onbooks this year (itemize):

3 Deductions on this return not chargedagainst book income this year (itemize):

7 Expenses recorded on books this yearand not deducted on this return (itemize):

4

Add lines 6 and 7 8 Income (line 5, page 1)—line 5 less line 8


5

Analysis of Other Earnings and Profits (Line 10, Schedule L) Distributions to qualify under section 992(c)

5 Balance at beginning of year

1

Other decreases (itemize):

6 Increases (itemize):

2

Add lines 4 through 6 7 Add lines 1 and 2

3 Balance at end of year (line 3 less line 7)

8 Deficit in earnings and profits

4

Analysis of Previously Taxed Income (Line 11, Schedule L) Deficit in earnings and profits


1

Distributions to qualify under section 992(c)

6 Deemed distributions under section 995(b)

2 Other decreases (itemize):

7 Other increases (itemize):

3

Add lines 5 through 7 8 Balance at end of year (line 4 less line 8)


4

Analysis of Accumulated IC-DISC Income (Line 13, Schedule L) Distributions to qualify under section 992(c)


1

Distributions upon disqualification (sec. 995(b)(2))

7 Increases (itemize):


8

Add lines 1 and 2

3 Add lines 4 through 8 9 Deficit in earnings and profits

4

Balance at end of year (line 3 less line 9)

10 Redemptions under section 996(d)

5

Schedule M-2

Schedule M-1

Schedule L

Schedule M-3

Schedule M-4




Export Gross Receipts of the IC-DISC and Related U.S. Persons (see instructions) 1 See page 16 of the instructions and enter the product code and percentage of total export gross receipts for (a) the largest

and (b) 2nd largest product or service sold or provided by the IC-DISC:

Export gross receipts for the current tax year 2 Export gross receipts of related U.S. persons

(a) Export gross receipts of the IC-DISC (c) All other related U.S. persons (b) Related IC-DISCs

If item 2(b) or 2(c) is completed, complete the following (if more space is needed, attach a schedule following the format below): 3

(b) All Other Related U.S. Persons in Your Controlled Group

Identifying number Address Name

(a) IC-DISCs in Your Controlled Group

Identifying number Address Name

Other Information (see instructions) Yes No

See page 15 of the instructions and enter the main: Product or service � Business activity �

Did 95% or more of the IC-DISC’s gross receipts for the tax year consist of qualified export receipts (defined in section 993(a))?

Did the adjusted basis of the IC-DISC’s qualified export assets (as defined in section 993(b)) at the end of the tax year equal or exceed 95% of the sum of the adjusted basis of all the IC-DISC’s assets at the end of the tax year?

If a or b is “No,” did the IC-DISC make a pro rata distribution of property as defined in section 992(c)? Did the IC-DISC have more than one class of stock at any time during the tax year?

Was the par or stated value of the IC-DISC’s stock at least $2,500 on each day of the tax year (for a newcorporation, this means on the last day for making an election to be an IC-DISC and for each later day)?

Did the IC-DISC keep separate books and records? Does the IC-DISC or any member of the IC-DISC’s controlled group (as defined in section 993(a)(3)) have operations

in or related to any country (or with the government, a company, or a national of that country) associated withcarrying out the boycott of Israel that is on the list kept by the Secretary of the Treasury under section 999(a)(3)?

Did the IC-DISC or any member of the controlled group of which the IC-DISC is a member have operations inany unlisted country that the IC-DISC knows or has reason to know requires participation in or cooperation with an international boycott against Israel?

Did the IC-DISC or any member of the controlled group of which the IC-DISC is a member have operations inany country that the IC-DISC knows or has reason to know requires participation in or cooperation with aninternational boycott other than the boycott of Israel?

If the answer to any of the questions in 6 is “Yes,” see instructions and Form 5713, International Boycott Report.

Enter the amount of tax-exempt interest income received or accrued during the tax year � $

Schedule N

Schedule O

1 a

b

c

2a

3 4 5 6a

7

b

b c

(a) Code % Percentage of total (b) Code % Percentage of total


Note: If the IC-DISC, at any time during the tax year, had assets or operated a business in a foreign country orU.S. possession, it may be required to attach Schedule N (Form 1120), Foreign Operations of U.S. Corporations,to this return. See Schedule N for details.


Form



Annual Return To Report Transactions WithForeign Trusts and Receipt of Certain Foreign Gifts

OMB No. 1545-0159

For calendar year 2010, or tax year beginning , 2010, ending , 20 Check appropriate boxes:

Initial return

Final return

Amended return

Note. All information must be in English. Show all amounts in U.S. dollars. File a separate Form 3520 for each foreign trust.

1a

b

2a

c

Name of person(s) filing return (see instructions)

Identification number

Number, street, and room or suite no. (if a P.O. box, see instructions)

City or town

Name of foreign trust (if applicable)

Employer identification number (if any)

(a) You are a U.S. transferor who, directly or indirectly, transferred money or other property during the current tax year to a foreign trust, (b)You held an outstanding obligation of a related foreign trust (or a person related to the trust) issued during the current tax year, that youreported as a “qualified obligation” (defined in the instructions) during the current tax year, or (c) You are the executor of the estate of a U.S.decedent and (1) the decedent made a transfer to a foreign trust by reason of death, (2) the decedent was treated as the owner of anyportion of a foreign trust immediately prior to death, or (3) the decedent’s estate included any portion of the assets of a foreign trust.Complete all applicable identifying information requested below and Part I of the form and see the instructions for Part I.

You are a U.S. owner of all or any portion of a foreign trust at any time during the tax year. Complete all applicable identifyinginformation requested below and Part II of the form and see the instructions for Part II.

(a) You are a U.S. person who, during the current tax year, received a distribution from a foreign trust, or (b) You are a U.S. person and youare also a grantor or beneficiary of a foreign trust that has made a loan of cash or marketable securities directly or indirectly to you duringthe current tax year that you reported as a “qualified obligation” (defined in the instructions) during the current tax year. Complete allapplicable identifying information requested below and Part III of the form and see the instructions for Part III.

You are a U.S. person who, during the current tax year, received certain gifts or bequests from a foreign person. Complete all applicableidentifying information requested below and Part IV of the form and see the instructions for Part IV.

Service Center where U.S. person’s income tax return is filed �

Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of my knowledge and belief, it is true, correct, and complete.

Signature

Title

Date

Cat. No. 19594V

Form 3520 (2010)

d

Spouse’s identification number

c

e

Country

h

State or province

f

ZIP or postal code

g

b


City or town

d

Country

g

State or province

e

ZIP or postal code

f

4a

Name of U.S. decedent (see instr.)

b

Address

c

TIN of decedent

e

EIN of estate

d

Date of death

Check box that applies to person filing return:

Individual

Partnership

Corporation

Trust

Executor


Did the foreign trust appoint a U.S. agent (defined in the instructions) who can provide the IRS with all relevant trustinformation?

Yes

No If “Yes,” complete lines 3a through 3g.

3

3a

Name of U.S. agent

c

Identification number (if any)

b


City or town

d

Country

g

State or province

e

ZIP or postal code

f

Check all applicable boxes:

For Privacy Act and Paperwork Reduction Act Notice, see instructions.

A B

�

Check applicable box:

f U.S. decedent made transfer to a foreign trust by reason of death.

U.S. decedent treated as owner of foreign trust immediately prior to death. Assets of foreign trust were included in estate of U.S. decedent.

10

SignHere

PaidPreparerUse Only

Print/Type preparer’s name

Preparer’s signature

Date

Check ifself-emp yed

PTIN

Firm’s name �

Firm’s address �

Firm’s EIN �

Phone no.

� �

■ ■


Form 3520 (2010)

Page 2

Yes

No

11a

12

13

Schedule A—Obligations of a Related Trust (see instructions)

During the current tax year, did you transfer property (including cash) to a related foreign trust in exchange for an obligation of the trust or an obligation of a person related to the trust (see instructions)?

If “Yes,” complete the rest of Schedule A, as applicable. If “No,” go to Schedule B.

(i)Date of transfer giving rise to obligation

(ii)Maximum term

(iii)Yield to maturity

(iv)FMV of obligation

Note. Generally, you must answer “Yes,” if you checked “Yes” to the question on line 11b. Schedule B—Gratuitous Transfers (see instructions)

During the current tax year, did you make any transfers (directly or indirectly) to the trust and receive less than FMV,or no consideration at all, for the property transferred?

If “Yes,” complete columns (a) through (i) below and the rest of Schedule B, as applicable.If “No,” go to Schedule C.

(a)Date oftransfer

(b)Descriptionof propertytransferred

(c)FMV of property

transferred

(d)U.S. adjusted

basis ofproperty

transferred

(e)Gain recognized

at time oftransfer

(f)Excess, if any,of column (c)

over the sum ofcolumns (d)

and (e)

(g)Descriptionof propertyreceived,

if any

(h)FMV of property

received

(i)Excess of

column (c) overcolumn (h)

Totals �

Yes

No

$

Yes

No

With respect to each qualified obligation you reported on line 11b: Do you agree to extend the period of assessment of any income or transfer tax attributable to the transfer, and any consequential income tax changes for each year that the obligation is outstanding, to a date 3 years after the maturity date of the obligation?

b

Were any of the obligations you received (with respect to a transfer described in 11a above) qualified obligations?

Yes

No If “Yes,” complete the rest of Schedule A with respect to each qualified obligation.

You are required to attach a copy of each sale or loan document entered into in connection with a transfer reported on line 13. If thesedocuments have been attached to a Form 3520 filed within the previous 3 years, attach only relevant updates.

b

Are you attaching a copy of: Sale document?

Loan document?

Yes

No

AttachedPreviously

YearAttached

a c

Subsequent variances to original sale or loan documents?

14

8

Was the transfer a completed gift or bequest? If “Yes,” see instructions

Yes

No 9a

b

Yes

No Yes

No

Now or in the future, can any part of the income or corpus of the trust benefit any U.S. beneficiary? If “No,” could the trust be revised or amended to benefit a U.S. beneficiary?

Will you continue to be treated as the owner of the transferred asset(s) after the transfer?

10

Yes

No

$

Form 3520 (2010)

5a

c

6a

Part I

Transfers by U.S. Persons to a Foreign Trust During the Current Tax Year (see instructions) Name of trust creator


Country code of country where trust was created

Country code of country whose law governs the trust

Date trust was created

b

Address

c

b

Will any person (other than the U.S. transferor or the foreign trust) be treated as the owner of the transferred assets after the transfer?

Yes

No

7a (i)

Name of other foreigntrust owners, if any

(ii)Address

(iii)Country of residence

(iv)Identification number,

if any

(v)Relevant

Code section

b

If “No,” go to Schedule B and, when completing columns (a) through (i) of line 13 with respect to each nonqualifiedobligation, enter “-0-” in column (h).

■


Form 3520 (2010)

Page 3

15

(a)Name of beneficiary

(b)Address of beneficiary

(d)Identification number, if any

If you checked “No” on line 3 (or did not complete lines 3a through 3g), you are required to attach a copy of all trust documents as indicated below. If these documents have been attached to a Form 3520-A filed within the previous 3 years, attach only relevant updates.

(c)U.S. beneficiary?

Yes

No

b

Are you attaching a copy of:

The trust instrument? Memoranda or letters of wishes?

Summary of all written and oral agreements and understandings relating to the trust?

Subsequent variances to original trust documents?

Yes

No

AttachedPreviously

YearAttached

a

c d f

Other trust documents?

18

(a)Name of trustee

(b)Address of trustee

(c)Identification number, if any

16

(a)Name of other persons

with trust powers

(b)Address of other persons with trust powers

(d)Identification number, if any

(c)Description of

powers

17

Note. Complete lines 15 through 18 only if you answered “No” to line 3.

Part I

Schedule B—Gratuitous Transfers (Continued)

Trust financial statements?

e

Form 3520 (2010)

Schedule C—Qualified Obligations Outstanding in the Current Tax Year (see instructions) 19

Did you, at any time during the tax year, hold an outstanding obligation of a related foreign trust (or a person related to the trust) that you reported as a “qualified obligation” in the current tax year?

If “Yes,” complete columns (a) through (e) below.

(a)Date of original

obligation

(b)Tax year qualified

obligation first reported

(c)Amount of principal

payments made duringthe tax year

(d)Amount of interest


(e)Does the obligation

still meet thecriteria for a

qualified obligation?

Yes

No

Yes

No


Form 3520 (2010)

Page 4

Part III

Part II

U.S. Owner of a Foreign Trust (see instructions) (a)

Name of other foreigntrust owners, if any

(b)Address

(c)Country of residence

(d)Identification number,

if any

(e)Relevant

Code section

(a)Country code of country where foreign trust

was created

(b)Country code of country whose law governs the foreign trust

(c)Date foreign trust was created

20

21

Did the foreign trust file Form 3520-A for the current year? If “Yes,” attach the Foreign Grantor Trust Owner Statement you received from the foreign trust.

If “No,” to the best of your ability, complete and attach a substitute Form 3520-A for the foreign trust. See instructions for information on penalties. Enter the gross value of the portion of the foreign trust that you are treated as owning �

Yes

No

Distributions to a U.S. Person From a Foreign Trust During the Current Tax Year (see instructions)

22

Cash amounts or FMV of property received, directly or indirectly, during the current tax year, from the foreign trust (exclude loans included on line 25).

(a)Date of distribution

(b)Description of property received

(c)FMV of property received

(determined on date ofdistribution)

23

24

Totals �

$

$

(d)Description of

property transferred,if any

(e)FMV of property

transferred

(f)Excess of column (c)

over column (e)

Form 3520 (2010)

28

(a)Date of original loan

transaction

(c)Amount of principal


(d)Amount of

interest paymentsmade duringthe tax year

(e)Does the loan still meet the

criteria of a qualifiedobligation? Yes

No

(b)Tax year

qualified obligationfirst reported

Did the trust, at any time during the tax year, hold an outstanding obligation of yours (or a person related to you)that you reported as a “qualified obligation” in the current tax year?

If “Yes,” complete columns (a) through (e) below for each obligation.

Yes

No

(a)FMV of loan proceeds

(b)Date of originalloan transaction

(c)Maximum term of

repayment ofobligation

(d)Interest rateof obligation

(e)Is the obligation a

“qualified obligation?” Yes

No

(f)FMV of qualified

ob ation

(g)Amount treated as distribution

from the trust (subtractcolumn (f) from column (a))

Note. Generally, you must answer “Yes” if you checked “Yes” in column (e) of line 25.

With respect to each obligation you reported as a “qualified obligation” on line 25: Do you agree to extend theperiod of assessment of any income or transfer tax attributable to the transaction, and any consequential incometax changes for each year that the obligation is outstanding, to a date 3 years after the maturity date of theobligation?

Total distributions received during the current tax year. Add line 24, column (f), and line 25, column (g) �

$

26

Yes

No

$

27

During the current tax year, did you (or a person related to you) receive a loan from a related foreign trust (including anextension of credit upon the purchase of property from the trust)?

Yes

No

25

If “Yes,” complete columns (a) through (g) below for each such loan.

Total �

Note. You are considered to have received a loan if you (or a person related to you) were permitted the uncompensated use of trust property (as described in section 643(i)). See instructions for additional information, including how to complete columns (a) through (g) for such transactions.


Form 3520 (2010)

Page 5 Part III

Distributions to a U.S. Person From a Foreign Trust During the Current Tax Year (Continued)

Schedule A—Default Calculation of Trust Distributions (see instructions)

36

Enter amount from line 27

37

Enter total distributions received from the foreign trust during the 3 preceding tax years (or during the number ofyears the trust has been a foreign trust, if fewer than 3)

39

Average distribution. Divide line 34 by 3 (or the number of years the trust has been a foreign trust, if fewer than 3) and enter the result

40a

Amount treated as accumulation distribution. Subtract line 36 from line 31. If -0-, do not complete the rest of Part III

42a

Number of years the trust has been a foreign trust (see instructions) �

43

Applicable number of years of trust. Divide line 32 by 2 and enter the result here �

Schedule B—Actual Calculation of Trust Distributions (see instructions)

44

Enter amount from line 27

45

Amount treated as ordinary income in the current tax year

46

Amount treated as accumulation distribution. If -0-, do not complete Schedule C, Part III

47

Amount treated as net short-term capital gain in the current tax year

Amount treated as distribution from trust corpus Enter any other distributed amount received from the foreign trust not included on lines 40a, 41a, 42a, 42b, and

43 (attach explanation)

Applicable number of years of trust. Divide line 46 by line 45 and enter the result here �

33

Did you receive a Foreign Grantor Trust Beneficiary Statement from the foreign trust with respect to adistribution?

34

Did you receive a Foreign Nongrantor Trust Beneficiary Statement from the foreign trust with respect to adistribution?

Yes

No

Yes

No

35

38

Multiply line 33 by 1.25

Amount treated as ordinary income earned in the current year. Enter the smaller of line 31 or line 35

41a

Amount of foreign trust’s aggregate undistributed net income Amount of foreign trust’s weighted undistributed net income

32

31

30

29

If “Yes,” attach the statement and complete either Schedule A or Schedule B below (see instructions). Alsocomplete Schedule C if you enter an amount greater than zero on line 37 or line 41a.

If “No,” complete Schedule A with respect to that distribution. Also complete Schedule C if you enter an amount greater than zero on line 37.

Form 3520 (2010)

If “No,” complete Schedule A with respect to that distribution. Also complete Schedule C if you enter an amount greater than zero on line 37.

48 49 50 51

Enter accumulation distribution from line 37 or 41a, as applicable Enter tax on total accumulation distribution from line 28 of Form 4970 (attach Form 4970—see instructions)

Combined interest rate imposed on the total accumulation distribution (see instructions) Interest charge. Multiply the amount on line 49 by the combined interest rate on line 51

Tax attributable to accumulation distributions. Add lines 49 and 52. Enter here and as “additional tax” on yourincome tax return

52 53

Schedule C—Calculation of Interest Charge (see instructions)

Enter applicable number of years of foreign trust from line 38 or 47, as applicable(round to nearest half-year) �

Unrecaptured section 1250 gain �

28% rate gain �

Amount of line 41a that is tax-exempt �

Qualified dividends �

b

b

b c d

Amount treated as net long-term capital gain in the current tax year

If “Yes,” attach the statement and do not complete the remainder of Part III with respect to that distribution.

N/A

N/A


Form 3520 (2010)

Page 6

(b)Description of property received

(a)Date of giftor bequest

(c)FMV of property received

Total �

$

U.S. Recipients of Gifts or Bequests Received During the Current Tax Year From Foreign Persons (see instructions)

Part IV

54

Yes

No

During the current tax year, did you receive more than $100,000 that you treated as gifts or bequests from anonresident alien or a foreign estate? See instructions for special rules regarding related donors and gifts or bequestsfrom “covered expatriates”

If “Yes,” complete columns (a) through (c) with respect to each such gift or bequest in excess of $5,000. If more spaceis needed, attach schedule.

During the current tax year, did you receive more than $14,165 that you treated as gifts from a foreign corporation or aforeign partnership? See instructions regarding related donors

If “Yes,” complete columns (a) through (g) with respect to each such gift. If more space is needed, attach schedule.

(a)Date of gift

(b)Name of foreign donor

(c)Address of foreign donor

(d)Identification number,

if any

(e)Check the box that applies to the foreign donor

Corporation

Partnership

(f)Description of property received

(g)FMV of property received

Do you have any reason to believe that the foreign donor, in making any gift or bequest described in lines 54 and 55, was acting as a nominee or intermediary for any other person? If “Yes,” see instructions

Yes

No

Yes

No

55

56

Form 3520 (2010)

During the current tax year, did you receive a “covered gift or bequest” (as defined in section 2801(e)) of more than $13,000 from a “covered expatriate” (as defined in section 877A(g)(1)) (see instructions)?

57

If “Yes,” complete and file Form 708, U.S. Return of Tax for Gifts and Bequests Received From Expatriates.

Yes

No

■ ■■ ■■ ■


Annual Information Return of ForeignTrust With a U.S. Owner

3520-A

Form

OMB No. 1545-0160


� See separate instructions. Note: All information must be in English. Show all amounts in U.S. dollars.

For calendar year 2010, or tax year beginning , 2010, ending , 20 .

Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best ofmy knowledge and belief, it is true, correct, and complete.

Date

Title

Trustee’s Signature


Form 3520-A (2010)

Cat. No. 19595G

General Information (see instructions) 1a

Name of foreign trust

b


c


d

City or town

e

State or province

f

ZIP or postal code

g

Country

3a

Name of U.S. agent

b


c


d

City or town

e

State or province

f

ZIP or postal code

g

Country

4a

Name of trustee

b

Identification number, if any

c


d

City or town

e

State or province

f

ZIP or postal code

g

Country

5

Did the trust transfer any property (including cash) to another person (see instructions for definition) during the taxyear? If “Yes,” attach statement (see instructions).

Part I


If “Yes,” skip lines 2a through 2e and go to line 3.

Yes

No

2

(Under section 6048(b))

Yes

No

If “No,” you are required to attach a copy of all trust documents as indicated below. If these documents have been attached to a Form3520-A filed within the previous 3 years, attach only relevant updates. Have you attached a copy of: a

Summary of all written and oral agreements and understandings relating to the trust?

Yes

No

AttachedPreviously

YearAttached

b

The trust instrument? c

Memoranda or letters of wishes?

d

Subsequent variances to original trust documents? e

Other trust documents?

Check appropriate boxes.

Initial return

Final return

Amended return

6

Enter the number of Foreign Grantor Trust Owner Statements (page 3) included with this Form 3520-A �

�

10

Firm’s EIN �

Date PTIN

PaidPreparerUse Only

Check ifself-employed Firm’s name �

Phone no. Firm’s address �

Print/Type preparer’s name Preparer’s signature

� � SignHere


Page 2

Form 3520-A (2010)

Foreign Trust Income StatementEnter totals from books and records of foreign trust (see instructions).

Inco

me

E

xpen

ses

Foreign Trust Balance Sheet

End of Tax Year

Beginning of Tax Year

(d)(c)

(b)(a)

Assets

Liabilities

Part II

1

Interest 2

Dividends

3

Gross rents and royalties

5

Capital gains: a

Net short-term capital gain (loss)

b

Net long-term capital gain (loss) 6

Ordinary gains (losses)

7

Other income (attach schedule) 8

Total income (add lines 1 through 7)

9

Interest expense 10a

Foreign taxes (attach schedule)

b

State and local taxes 11

Amortization and depreciation (depletion)

12

Trustee and advisor fees 13

Charitable contributions

14

Other expenses (attach schedule) 15

Total expenses (add lines 9 through 14)

16

Net income (loss) (subtract line 15 from line 8) 17a

Enter the fair market value (FMV) of total distributions from the trust to all persons, whether U.S. or foreign �

(i) Name of owner

(ii) Identification number

(iii) Date of distribution

Part III

3

Mortgages and notes receivable

1

Cash 2

Accounts receivable

4

Inventories 5

Government obligations

6

Other marketable securities 7

Other nonmarketable securities

8a

Depreciable (depletable) assets b

Less: accumulated depreciation (depletion)

9

Real property 10

Other assets (attach schedule)

11

Total assets

12

Accounts payable 13

Contributions, gifts, grants, etc., payable

14

Mortgages and notes payable 15

Other liabilities (attach schedule)

16

Total liabilities Net Worth

17

Contributions to trust corpus 18

Accumulated trust income

19

Other (attach schedule) 20

Total net worth (add lines 17 through 19)

21

Income (loss) from partnerships and fiduciaries

4

Distributions to U.S. owners:

Distributions to U.S. beneficiaries:

b

c

(iv) FMV

(i) Name of beneficiary

(ii) Identification number

(iii) Date of distribution

(iv) FMV

Total liabilities and net worth (add lines 16 and 20)

Form 3520-A (2010)

■■

■ ■


Page 3

Form 3520-A (2010)

2010 Foreign Grantor Trust Owner Statement (see instructions)

1a


b


c


d

City or town

e

State or province

f

ZIP or postal code

g

Country

3a

Name of U.S. agent

b


c


d

City or town

e

State or province

f

ZIP or postal code

g

Country

4a

Name of trustee

b


c


d

City or town

e

State or province

f

ZIP or postal code

g

Country

5

The tax year of the owner of the foreign trust to which this statement relates �

6a

Name of U.S. owner

b


c


d

City or town

e

State or province

f

ZIP or postal code

g

Country

9

Gross value of the portion of the trust treated as owned by the U.S. owner

$ 2010 Statement of Foreign Trust Income Attributable to U.S. Owner (see instructions)

1a

Taxable interest

2a

Total ordinary dividends

3

Gross rents and royalties

5

Capital gains (losses) 6

Ordinary gains (losses)

7

Other income (attach schedule) 8

Interest expense

9a

Foreign taxes (attach schedule) b

State and local taxes

10

Amortization and depreciation (depletion) 11

Trustee and advisor fees

12

Charitable contributions 13

Other expenses (attach schedule)

Did the foreign trust appoint a U.S. agent (defined in the instructions) who can provide the IRS with all relevant trust information?

2

Yes


Attach an explanation of the facts and law (including the section of the Internal Revenue Code) that establishes that the foreign trust (orportion of the foreign trust) is treated for U.S. tax principles as owned by the U.S. person.

7

4

Income from partnerships and fiduciaries

Inco

me

E

xpen

ses

Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of my knowledgeand belief, it is true, correct, and complete.

Date �

Title �

Trustee Signature �

Report each item on the proper form or schedule of your tax return.

If the trust did not appoint a U.S. agent, list the trust documents attached to Form 3520-A (see instructions).

8

Form 3520-A (2010)

h

Service Center where U.S. owner files its income tax returns �

Important: Trustee must prepare a separate statement for each U.S. owner and include a copy of each statement with Form 3520-A. Trustee is also requiredto send to each U.S. owner a copy of the owner’s statement. U.S. owner must attach a copy of its statement to Form 3520.

b

Tax-exempt interest �

Qualified dividends �

b


Page 4

Form 3520-A (2010)

2010 Foreign Grantor Trust Beneficiary Statement

1a


b


c


d

City or town

e

State or province

f

ZIP or postal code

g

Country

3a

Name of U.S. agent

b


c


d

City or town

e

State or province

f

ZIP or postal code

g

Country

4a

Name of trustee

b


c


d

City or town

e

State or province

f

ZIP or postal code

g

Country

5

The first and last day of the tax year of the foreign trust to which Form 3520-A applies �

6a

Name of U.S. beneficiary

b


c


d

City or town

e

State or province

f

ZIP or postal code

g

Country

7

Description of property (including cash) distributed, or treated as distributed, to the U.S. person during the tax year. (See the instructionsfor Part III of Form 3520 for U.S. tax treatment of these amounts.) (a) Description of property

(b) FMV

8

Attach an explanation of the facts and law (including the section of the Internal Revenue Code) that establishes that the foreign trust (orportion of the foreign trust) is treated for U.S. tax principles as owned by another person. 9

Owner of the foreign trust is (check one): Individual

Partnership

Corporation


Yes


2

Under penalties of perjury, I declare that I have examined this return, including any accompanying reports, schedules, or statements, and to the best of my knowledgeand belief, it is true, correct, and complete.

Date �

Title �

Trustee Signature �

Yes

No

If “No,” do you agree that either the IRS or the U.S. beneficiary can inspect and copy the trust’s permanent booksof account, records, and such other documents that are necessary to establish that the trust should be treated forU.S. tax purposes as owned by another person?

Form 3520-A (2010)

Important: Trustee must prepare a separate statement for each U.S. beneficiary that received a distribution from the trust during the tax year andinclude a copy of each statement with Form 3520-A. Trustee is also required to send to each such beneficiary a copy of thebeneficiary’s statement. U.S. beneficiary must attach a copy of its statement to Form 3520.


OMB No. 1545-0704

Information Return of U.S. Persons WithRespect To Certain Foreign Corporations

5471 Form

(Rev. December 2007) Information furnished for the foreign corporatio s annual ac ounting period (tax year required by

section 898) (see instructions) beginning , 20 , and ending , 20

Department of the TreasuryInternal Revenue Service Name of person filing this return Identifying number A

Category of filer (See instructions. Check applicable box(es)):

B Number, street, and room or suite no. (or P.O. box number if mail is not delivered to street address)

1 2 3 4 5 City or town, state, and ZIP code Enter the total percentage of the foreign corporation’s votin ock

you owned at the end of its annual accounting period %

C

Filer’s tax year beginning , 20 , and ending , 20

Important: Fill in all applicable lines and schedules. All information must be in English. All amounts must be statedin U.S. dollars unless otherwise indicated. b

Employer identification number, if any

Name and address of foreign corporation 1a

Country under whose laws incorporated

c

Principal business activity

g

Principal business activitycode number

f

Principal place of business

e

Date of incorporation

a

2 Provide the following information for the foreign corporation’s accounting period stated above.

If a U.S. income tax return was filed, enter:

b

(ii) U.S. income tax paid(after all credits)

Name, address, and identifying number of branch office or agent (if any) inthe United States (i) Taxable income or (loss)

Name and address (including corporate department, if applicable) ofperson (or persons) with custody of the books and records of the foreigncorporation, and the location of such books and records, if different

d

Name and address of foreign corporation’s statutory or resident agent incountry of incorporation

c

Stock of the Foreign Corporation (b)

Number of shares issued and outstanding

(ii) End of annualaccounting period

(i) Beginning of annualaccounting period

(a)

Description of each class of stock

For Paperwork Reduction Act Notice, see instructions. Form 5471 (Rev. 12-2007)


(4) Check applicable box(es) (3) Identifying number (2) Address (1) Name

Officer

Shareholder

Director

D Person(s) on whose behalf this information return is filed:

Schedule A

Cat. No. 49958V

d

Functional currency

h

(repealed)


■ ■


Page 2 Form 5471 (Rev. 12-2007)

U.S. Shareholders of Foreign Corporation (see instructions) (c) Number ofshares held atbeginning of

annualaccounting period

(d) Number ofshares held atend of annual

accountingperiod

(b) Description of each class of stock held byshareholder. Note: This description should match the

corresponding description entered in Schedule A,column (a).

(a) Name, address, and identifyingnumber of shareholder

Important: Report all information in functional currency in accordance with U.S. GAAP. Also, report each amount inU.S. dollars translated from functional currency (using GAAP translation rules). However, if the functional currency is the U.S. dollar, complete only the U.S. Dollars column. See instructions for special rules for DASTM corporations.

Income Statement (see instructions)

Gross receipts or sales

1a 1a

2 Cost of goods sold

2 3 Gross profit (subtract line 2 from line 1c)

3

4 Dividends

4 Inco

me

5 Interest

5 6a Gross rents

6a

7 Net gain or (loss) on sale of capital assets

7 8 Other income (attach schedule)

8

Total income (add lines 3 through 8)

9 9 10 Compensation not deducted elsewhere

10

11a Rents

11a

12 Interest

12 13 Depreciation not deducted elsewhere

13

14 Depletion

14 15 Taxes (exclude provision for income, war profits, and excess profits taxes)

15

Ded

ucti

ons

16 Other deductions (attach schedule—exclude provision for income, war profits,and excess profits taxes)

16

Total deductions (add lines 10 through 16)

17 17

18 Net income or (loss) before extraordinary items, prior period adjustments, andthe provision for income, war profits, and excess profits taxes (subtract line17 from line 9)

18 19 Extraordinary items and prior period adjustments (see instructions)

19

Provision for income, war profits, and excess profits taxes (see instructions)

20 20 Net

Inc

om

e

Current year net income or (loss) per books (combine lines 18 through 20)

21 21

(e) Pro rata shareof subpart F

income (enter asa percentage)

Schedule B

Schedule C

Functional Currency

U.S. Dollars

Returns and allowances Subtract line 1b from line 1a

b c

1b 1c

Form 5471 (Rev. 12-2007)

Gross royalties and license fees

b Royalties and license fees

b 6b

11b

■


Form 5471 (Rev. 12-2007) Page 3 Income, War Profits, and Excess Profits Taxes Paid or Accrued (see instructions)

Amount of tax (a)

Name of country or U.S. possession

(d)In U.S. dollars

(b)In foreign currency

1 U.S. 2 3 4

Total �

8

Balance Sheet

(b)End of annual

accounting period

(a)Beginning of annualaccounting period

Assets

1 Cash

1 2a Trade notes and accounts receivable

2a

) ( ) ( b Less allowance for bad debts 3 Inventories

3

4 4 5 5 6

Other current assets (attach schedule)

6 7

Loans to shareholders and other related persons

7 8a

Investment in subsidiaries (attach schedule)

8a 8b

Other investments (attach schedule)

9a 9a

Buildings and other depreciable assets

10

( ) ( )

9b

b Less accumulated depreciation

10 11

Depletable assets ) ( ) (

11a

b Less accumulated depletion

11b

12

Land (net of any amortization)

11c

13

Intangible assets: a Goodwill

11d

Organization costs

b

12

c Patents, trademarks, and other intangible assets ( ) ( )

13

Less accumulated amortization for lines 11a, b, and c

d

14 14

Other assets (attach schedule)

Total assets

15 15

Liabilities and Shareholders’ Equity

16

Accounts payable

17

Other current liabilities (attach schedule)

18a

Loans from shareholders and other related persons

19

Other liabilities (attach schedule)

20

Preferred stock

a Capital stock:

b Common stock

21

Paid-in or capital surplus (attach reconciliation) Retained earnings

22

) ( ) ( Less cost of treasury stock

Total liabilities and shareholders’ equity

2b

18b

16 17 18

19 20 21 22

(c)Conversion rate

Schedule E

Schedule F

5 6 7

Important: Report all amounts in U.S. dollars prepared and translated in accordance with U.S. GAAP. See instructions for an exception for DASTM corporations.

Form 5471 (Rev. 12-2007)

■


Page 4 Form 5471 (Rev. 12-2007)

1 Current year net income or (loss) per foreign books of account

1

Net adjustments made to line 1 to determine currentearnings and profits according to U.S. financial and taxaccounting standards (see instructions):

2 Net

Subtractions

NetAdditions

Capital gains or losses a Depreciation and amortization

b

Depletion

c Investment or incentive allowance

d

Charges to statutory reserves

e Inventory adjustments

f

Other (attach schedule)

g

Total net additions

3 Total net subtractions

4

Current earnings and profits (line 1 plus line 3 minus line 4)

5d

Summary of Shareholder’s Income From Foreign Corporation (see instructions)

1 1 Subpart F income (line 38b, Worksheet A in the instructions)

2 Earnings invested in U.S. property (line 17, Worksheet B in the instructions)

2 3 Previously excluded subpart F income withdrawn from qualified investments (line 6b, Worksheet C

in the instructions)

3

4 Previously excluded export trade income withdrawn from investment in export trade assets (line 7b, Worksheet D in the instructions)

4

6 6 Total of lines 1 through 5. Enter here and on your income tax return. See instructions

● Was any income of the foreign corporation blocked?

Factoring income

Taxes h

Schedule H

Schedule I

If the answer to either question is “Yes,” attach an explanation.

5a 5a

d Current earnings and profits in U.S. dollars (line 5c translated at the appropriate exchange rate asdefined in section 989(b) and the related regulations (see instructions))

Enter exchange rate used for line 5d �

Dividends received (translated at spot rate on payment date under section 989(b)(1))

Exchange gain or (loss) on a distribution of previously taxed income

7

8

7

8

c b DASTM gain or (loss) for foreign corporations that use DASTM (see instructions)

Combine lines 5a and 5b

5b 5c

5 5

Current Earnings and Profits (see instructions)

No Yes

● Did any such income become unblocked during the tax year (see section 964(b))?

Important: Enter the amounts on lines 1 through 5c in functional currency.

Other Information Schedule G

During the tax year, did the foreign corporation own at least a 10% interest, directly or indirectly, in any foreignpartnership?

No Yes

During the tax year, did the foreign corporation own an interest in any trust? During the tax year, did the foreign corporation own any foreign entities that were disregarded as entities separate

from their owners under Regulations sections 301.7701-2 and 301.7701-3 (see instructions)? If “Yes,” you are generally required to attach Form 8858 for each entity (see instructions).

If “Yes,” see the instructions for required attachment.

1

2 3

Form 5471 (Rev. 12-2007)

During the tax year, was the foreign corporation a participant in any cost sharing arrangement?

4 During the course of the tax year, did the foreign corporation become a participant in any cost sharing arrangement?

5

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SCHEDULE M Transactions Between Controlled Foreign Corporationand Shareholders or Other Related Persons

OMB No. 1545-0704

(Form 5471) (Rev. December 2007) Department of the TreasuryInternal Revenue Service

� Attach to Form 5471. See Instructions for Form 5471. Identifying number Name of person filing Form 5471

Name of foreign corporation

Important: Complete a separate Schedule M for each controlled foreign corporation. Enter the totals for each type of transaction that occurred during the annual accounting period between the foreign corporation and the persons listed in columns (b) through (f). All amounts must be stated in U.S.dollars translated from functional currency at the average exchange rate for the foreign corporation’s tax year. See instructions.

(c) Any domesticcorporation or

partnership controlledby U.S. person filing

this return

(a) Transactionsof

foreign corporation

(b) U.S. personfiling this return

(f) 10% or more U.S.shareholder of any

corporationcontrolling the

foreign corporation

(e) 10% or more U.S.shareholder of controlled

foreign corporation(other than the U.S.

person filing this return)

(d) Any other foreigncorporation or

partnership controlledby U.S. person filing

this return

1 Sales of stock in trade (inventory)

3 Sales of property rights(patents, trademarks, etc.)

Compensation received for technical, managerial, engineering,construction, or like services

6

7 Commissions received 8 Rents, royalties, and license

fees received 9 Dividends received (exclude

deemed distributions undersubpart F and distributions ofpreviously taxed income)

10 Interest received 11 Premiums received for insur-

ance or reinsurance

Purchases of stock in trade(inventory)

Purchases of tangible propertyother than stock in trade

14

15 Purchases of property rights(patents, trademarks, etc.)

Compensation paid for tech-nical, managerial, engineering,construction, or like services

18

19 Commissions paid 20 Rents, royalties, and license

fees paid Dividends paid

21 22 Interest paid

25

Schedule M (Form 5471) (Rev. 12-2007) For Paperwork Reduction Act Notice, see the Instructions for Form 5471.

13


26

Add lines 1 through 11

Amounts loaned (enter themaximum loan balance duringthe year) — see instructions

Amounts borrowed (enter themaximum loan balance duringthe year) — see instructions

Cat. No. 49963O

Enter the relevant functional currency and the exchange rate used throughout this schedule �

2 Sales of tangible property otherthan stock in trade

23 Premiums paid for insurance orreinsurance

12

4 Buy-in payments received 5 Cost sharing payments received

Buy-in payments paid

16 Cost sharing payments paid

17

■ ■

■ ■ ■ ■

■ ■

■ ■ ■ ■ ■

■ ■ ■ ■ ■

■ ■ ■ ■ ■

■ ■


Form 5713(Rev. December 2010)


International Boycott Report

For tax year beginning , 20 ,

and ending , 20 . ▶ Controlled groups, see instructions.

OMB No. 1545-0216


Paper filers must file in duplicate (see When and Where to File in the instructions)

Name Identifying number



Address of service center where your tax return is filed

Type of filer (check one): Individual Partnership Corporation Trust Estate Other

1 Individuals—Enter adjusted gross income from your tax return (see instructions) 2 Partnerships and corporations: a Partnerships—Enter each partner’s name and identifying number.

b Corporations—Enter the name and employer identification number of each member of the controlled group (as defined in section 993(a)(3)). Do not list members included in the consolidated return; instead, attach a copy of Form 851. List all other members of the controlled group not included in the consolidated return. If you list any corporations below or if you attach Form 851, you must designate a common tax year. Enter on line 4b the name and employer identification number of the corporation whose tax year is designated.


If more space is needed, attach additional sheets and check this box . . . . . . . . . . . . . . . . . ▶Code Description

c Enter principal business activity code and description (see instructions) d IC-DISCs—Enter principal product or service code and description (see instructions)

3 Partnerships—Each partnership filing Form 5713 must give the following information: a Partnership’s total assets (see instructions) . . . . . . . . . . . . . . .b Partnership’s ordinary income (see instructions) . . . . . . . . . . . . .

4 Corporations—Each corporation filing Form 5713 must give the following information: a Type of form filed (Form 1120, 1120-FSC, 1120-IC-DISC, 1120-L, 1120-PC, etc.) . . .b Common tax year election (see instructions)

(1) Name of corporation ▶ (2) Employer identification number . . . . . . . . . . . . . . . . .(3) Common tax year beginning , 20 , and ending , 20 .

c Corporations filing this form enter: (1) Total assets (see instructions) . . . . . . . . . . . . . . . . . .(2) Taxable income before net operating loss and special deductions (see instructions) . .

5 Estates or trusts—Enter total income (Form 1041, page 1) . . . . . . . . .

6 Enter the total amount (before reduction for boycott participation or cooperation) of the following tax benefits (see instructions): a Foreign tax credit . . . . . . . . . . . . . . . . . . . . . . .b Deferral of earnings of controlled foreign corporations . . . . . . . . . . .c Deferral of IC-DISC income . . . . . . . . . . . . . . . . . . . .d FSC exempt foreign trade income . . . . . . . . . . . . . . . . . .e Foreign trade income qualifying for the extraterritorial income exclusion . . . . .

Please Sign Here

Under penalties of perjury, I declare that I have examined this report, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete.

▲

Signature Date

▲

Title

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 12030E Form 5713 (Rev. 12-2010)


Form 5713 (Rev. 12-2010) Page 2 Yes No 7 a Are you a U.S. shareholder (as defined in section 951(b)) of any foreign corporation (including a FSC that does not

use the administrative pricing rules) that had operations reportable under section 999(a)? . . . . . . . . b If the answer to question 7a is “Yes,” is any foreign corporation a controlled foreign corporation (as defined in

section 957(a))? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .c Do you own any stock of an IC-DISC? . . . . . . . . . . . . . . . . . . . . . . . . .d Do you claim any foreign tax credit? . . . . . . . . . . . . . . . . . . . . . . . . . .e Do you control (within the meaning of section 304(c)) any corporation (other than a corporation included in this

report) that has operations reportable under section 999(a)? . . . . . . . . . . . . . . . . . . If “Yes,” did that corporation participate in or cooperate with an international boycott at any time during its tax year that ends with or within your tax year? . . . . . . . . . . . . . . . . . . . . . . .

f Are you controlled (within the meaning of section 304(c)) by any person (other than a person included in this report) who has operations reportable under section 999(a)? . . . . . . . . . . . . . . . . . . If “Yes,” did that person participate in or cooperate with an international boycott at any time during its tax year that ends with or within your tax year? . . . . . . . . . . . . . . . . . . . . . . . . .

g Are you treated under section 671 as the owner of a trust that has reportable operations under section 999(a)? . h Are you a partner in a partnership that has reportable operations under section 999(a)? . . . . . . . . . i Are you a foreign sales corporation (FSC) (as defined in section 922(a), as in effect before its repeal)? . . . .j Are you excluding extraterritorial income (defined in section 114(e), as in effect before its repeal) from

gross income? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part I Operations in or Related to a Boycotting Country (see instructions) Yes No 8 Boycott of Israel—Did you have any operations in or related to any country (or with the government, a company,

or a national of that country) associated in carrying out the boycott of Israel which is on the list maintained by the Secretary of the Treasury under section 999(a)(3)? (See Boycotting Countries in the instructions.) . . . . .If “Yes,” complete the following table. If more space is needed, attach additional sheets using the exact format and check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

Name of country

(1)

Identifying number of person having operations

(2)


Code (3)

Description (4)

IC-DISCs only—Enter

product code (5)

a

b

c

d

e

f

g

h

i

j

k

l

m

n

Form 5713 (Rev. 12-2010)

o


Form 5713 (Rev. 12-2010) Page 3 Yes No

9 Nonlisted countries boycotting Israel— Did you have operations in any nonlisted country which you know or have reason to know requires participation in or cooperation with an international boycott directed against Israel? If “Yes,” complete the following table. If more space is needed, attach additional sheets using the exact format and check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

Name of country

(1)


(2)


Code (3)

Description (4)


product code (5)

a

b

c

d

e

f

g

h Yes No

10 Boycotts other than the boycott of Israel—Did you have operations in any other country which you know or have reason to know requires participation in or cooperation with an international boycott other than the boycott of Israel? If “Yes,” complete the following table. If more space is needed, attach additional sheets using the exact format and check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

Name of country

(1)


(2)


Code (3)

Description (4)


product code (5)

a

b

c

d

e

f

g

h Yes No

11 Were you requested to participate in or cooperate with an international boycott? . . . . . . . . . . . If “Yes,” attach a copy (in English) of any and all such requests received during your tax year. If the request was in a form other than a written request, attach a separate sheet explaining the nature and form of any and all such requests. (See instructions.)

12 Did you participate in or cooperate with an international boycott? . . . . . . . . . . . . . . . .If “Yes,” attach a copy (in English) of any and all boycott clauses agreed to, and attach a general statement of the agreement. If the agreement was in a form other than a written agreement, attach a separate sheet explaining the nature and form of any and all such agreements. (See instructions.)

Note: If the answer to either question 11 or 12 is “Yes,” you must complete the rest of Form 5713. If you answered “Yes” to question 12, you must complete Schedules A and C or B and C (Form 5713).

Form 5713 (Rev. 12-2010)


Form 5713 (Rev. 12-2010) Page 4 Part II Requests for and Acts of Participation in or Cooperation With an International

Boycott Requests Agreements

Yes No Yes No 13 a Did you receive requests to enter into, or did you enter into, any agreement (see instructions):

(1) As a condition of doing business directly or indirectly within a country or with the government, a company, or a national of a country to— (a) Refrain from doing business with or in a country which is the object of an international

boycott or with the government, companies, or nationals of that country? (b) Refrain from doing business with any U.S. person engaged in trade in a country which is the

object of an international boycott or with the government, companies, or nationals of that country? . . . . . . . . . . . . . . . . . . . . . . . . . . .

(c) Refrain from doing business with any company whose ownership or management is made up, in whole or in part, of individuals of a particular nationality, race, or religion, or to remove (or refrain from selecting) corporate directors who are individuals of a particular nationality, race, or religion?

(d) Refrain from employing individuals of a particular nationality, race, or religion? (2) As a condition of the sale of a product to the government, a company, or a national of a country,

to refrain from shipping or insuring products on a carrier owned, leased, or operated by a person who does not participate in or cooperate with an international boycott? . . . . . . . .

b Requests and agreements—if the answer to any part of 13a is “Yes,” complete the following table. If more space is needed, attach additional sheets using the exact format and check this box . . . . . . . . . . . . . . . ▶

Name of country

(1)

Identifying number of person receiving the request or having the

agreement (2)


Code (3)

Description (4)

IC-DISCs only— Enter

product code (5)

Type of cooperation or participation

Number of requests Number of agreements

Total (6)

Code (7)

Total (8)

Code (9)

a

b

c

d

e

f

g

h

i

j

k

l

m

n

o

p Form 5713 (Rev. 12-2010)


SCHEDULE A (Form 5713)



International Boycott Factor (Section 999(c)(1))

Complete only if you are not computing a loss of tax benefits using the specifically attributable taxes and income method on Schedule B (Form 5713)

▶ Attach to Form 5713. ▶ See instructions on page 2.

OMB No. 1545-0216


Name of country being boycotted (check one): Israel Other (identify) ▶

Important: If you are involved in more than one boycott, use a separate Schedule A for each boycott and attach to Form 5713.

Name of Country

(1)

Purchases, sales, and payroll attributable to boycotting operations, by operation

Boycott purchases (2)

Boycott sales (3)

Boycott payroll (4)

a

b

c

d

e

f

g

h

i

j

k

l

m

n

o

Total . . . . . . . . . . . . . . .

1 Numerator of boycott factor (add totals of columns (2), (3), and (4)) . . . . . . . . . . .2 Denominator of boycott factor: a Total purchases from countries other than United States . . . . .

b Total sales to or from countries other than United States . . . . .c Total payroll paid or accrued for services performed in countries other

than United States . . . . . . . . . . . . . . . . . .

d Total of lines 2a, b, and c . . . . . . . . . . . . . . . . . . . . . . . .3 International boycott factor (divide line 1 by line 2d). Enter here and on Schedule C (Form 5713)

(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

For Paperwork Reduction Act Notice, see the Instructions for Form 5713. Cat. No. 12050W Schedule A (Form 5713) (Rev. 12-2010)


Schedule A (Form 5713) (Rev. 12-2010) Page 2

General Instructions References are to the Internal Revenue Code.

Who Must File Complete Schedule A (Form 5713) if: • You participated in or cooperated with an international boycott and • You are using the international boycott factor to figure the loss of tax benefits.

You must use the international boycott factor to figure the reduction to foreign trade income qualifying for the extraterritorial income exclusion. To figure the loss of all other applicable tax benefits, you may either use the international boycott factor or you may specifically attribute taxes and income by operation on Schedule B (Form 5713).

Boycott Operations All your operations in a boycotting country are considered to be boycott operations, unless you rebut the presumption of participating in or cooperating with the boycott (as explained below). In addition, your operations that are not in a boycotting country are boycott operations if they are connected to your participation in or cooperation with the boycott. Rebutting the presumption of boycott participation or cooperation. One act of participation or cooperation creates the presumption that you participate in or cooperate with the boycott unless you rebut the presumption. The presumption applies to all your operations and those of each member of any controlled groups (defined in section 993(a)(3)) to which you belong, in each country that helps carry out the boycott.

You can rebut the presumption of participation in or cooperation with a boycott for a particular operation by demonstrating that the operation is separate from any participation in or cooperation with an international boycott. The presumption applies only to operations in countries that carry out the boycott. Therefore, you do not need to rebut the presumption for operations that are related to those countries if the operations take place outside of those countries.

International Boycott Factor Your international boycott factor reflects boycott purchases, boycott sales, and boycott payroll. Controlled groups. All members of a controlled group generally share one

international boycott factor, which reflects all their purchases, sales, and payroll. However, if you belong to two or more controlled groups, your international boycott factor will reflect the purchases, sales, and payroll of all the controlled groups to which you belong. Partnerships and trusts. You are deemed to have a prorated share of the purchases, sales, and payroll of each partnership in which you are a partner and of each trust of which you are treated as the owner under section 671. As a result, your international boycott factor may also reflect purchases, sales, and payroll of partnerships or trusts.

Specific Instructions Compute a separate boycott factor and a separate schedule for each international boycott you participated in or cooperated with. Include your own operations and, if applicable, the operations of partnerships, trusts, and members of your controlled group.

See the instructions for lines 8 through 13, in the Instructions for Form 5713, to determine the years for which you should report purchases, sales, and payroll for partnerships, trusts, and controlled groups.

Columns (1) Through (4) In completing columns (1) through (4), show all boycott purchases, boycott sales, and boycott payroll from one operation on one line. Partnerships. Complete only lines a through o, the total of columns (2), (3), and (4), and line 2. Do not complete line 3. Give this information to all partners so they can compute their own international boycott factor. Column (1). Enter the name of the country that requires participation in or cooperation with an international boycott as a condition of doing business in that country. The country named in column (1) is not necessarily the country in which the operation takes place. For example, if you have an operation in Country Z that is not a boycotting country and the operation relates to Country X that is a boycotting country, enter the name of Country X in column (1). The Secretary maintains a list, under section 999(a)(3), of countries that require participation in or cooperation with an international boycott. See the Instructions for Form 5713 for the current list of boycotting countries.

Column (2). Enter all purchases that are made from boycotting countries that are attributable to the operation reported on each line. Column (3). Enter the sales that are made to or from boycotting countries and that are attributable to the operation reported on each line. Column (4). Enter the total payroll that was paid or accrued for services performed in boycotting countries and that are attributable to the operation reported on each line.

Lines 1 Through 3 Line 1. Add the totals of columns (2), (3), and (4). This amount is the numerator of your international boycott factor.

Do not include amounts attributable to operations for which you rebutted the presumption of participating in or cooperating with the boycott. Line 2. The denominator of the international boycott factor reflects all your purchases, sales, and payroll in or related to all countries other than the United States. If applicable, the denominator also reflects these items for your controlled groups, partnerships, and trusts. Include the amounts that are attributable to operations for which you rebutted the presumption of participating in or cooperating with the boycott.Line 3. Enter the international boycott factor from line 3 of this form on the appropriate line of Schedule C (Form 5713) as follows.

IF you . . .

THEN enter the international boycott factor on . . .

Are required to reduce your foreign tax credit,

Line 2a(2).

Are denied a tax deferral on subpart F income,

Line 3a(4).

Are denied a tax deferral on IC-DISC income,

Line 4a(2).

Are denied an exemption of foreign trade income of a FSC,

Line 5a(2).

Are required to reduce foreign trade income qualifying for the extraterritorial income exclusion,

Line 6b.


SCHEDULE B (Form 5713)



Specifically Attributable Taxes and Income (Section 999(c)(2))

▶ Complete only if you are not computing a loss of tax benefits

using the international boycott factor on Schedule A (Form 5713).

▶ Attach to Form 5713. ▶ See instructions on page 2.

OMB No. 1545-0216


Name of country being boycotted (check one) Israel Other (identify) ▶

Important: If you are involved in more than one international boycott, use a separate Schedule B (Form 5713) to compute the specifically attributable taxes and income for each boycott.

Specifically Attributable Taxes and Income by Operation (Use a separate line for each operation.)

Principal business activity Foreign tax credit Subpart F income IC-DISC income FSC income

Name of country

(1)

Code

(2)

Description

(3)

Foreign taxes attributable to

boycott operations

(4)

Prorated share of international

boycott income

(5)

Taxable income attributable to

boycott operations

(6)

Taxable income attributable to

boycott operations

(7)

a

b

c

d

e

f

g

h

i

j

k

l

m

n

o Total . . . . . . . . . . . . . . . . . ▶

For Paperwork Reduction Act Notice, see the instructions for Form 5713. Cat. No. 12060S Schedule B (Form 5713) (Rev. 12-2010)


Schedule B (Form 5713) (Rev. 12-2010) Page 2

General Instructions Section references are to the Internal Revenue Code unless otherwise noted.

Who Must File Complete Schedule B (Form 5713) if: • You participated in or cooperated with an international boycott and • You figure the loss of tax benefits by specifically attributing taxes and income.

If you do not specifically attribute taxes and income for this purpose, you must compute the international boycott factor on Schedule A (Form 5713).

Do not use Schedule B (Form 5713) to figure the reduction to foreign trade income qualifying for the extraterritorial income exclusion. Instead, use Schedule A (Form 5713). Certain shareholders. IC-DISC benefits, certain FSC benefits, the “deemed paid” foreign tax credit under section 902, and the deferral of subpart F income are lost at the shareholder level. Shareholders in an IC-DISC, certain FSCs, or a foreign corporation must report their prorated share of the tax benefits denied. The denial of these benefits is discussed in the specific instructions for columns (4) through (7).

Boycott Operations All of your operations in a boycotting country are considered to be boycott operations, unless you rebut the presumption of participation in or cooperation with the boycott (as explained below). In addition, your operations that are not in a boycotting country are boycott operations if they are connected to your participation in or cooperation with the boycott. Rebutting the presumption of boycott participation or cooperation. One act of participation or cooperation creates the presumption that you participate in or cooperate with the boycott unless you rebut the presumption. The presumption applies to all of your operations and those of each member of any controlled groups (defined in section 993(a)(3)) to which you belong, in each country that helps carry out the boycott.

You can rebut the presumption of participation in or cooperation with a boycott for a particular operation by demonstrating that the operation is separate from any participation in or

cooperation with an international boycott. The presumption applies only to operations in countries that carry out the boycott. Therefore, you do not need to rebut the presumption for operations that are related to those countries if the operations take place outside of those countries.

Specific Instructions File Schedule B (Form 5713) for the period covered by your income tax return. Report only your own taxes and income; do not include the taxes and income of other members of any controlled groups to which you belong.

Columns (1) through (7) In completing columns (1) through (7), show all specifically identifiable taxes and income in each appropriate column from one operation on one line.

Column (1). Enter the name of the country that requires participation in or cooperation with an international boycott as a condition of doing business in that country. The country named in column (1) is not necessarily the country where you have operations. For example, if you have operations in Country Z that is not a boycotting country and the operation relates to Country X that is a boycotting country, enter the name of Country X in column (1). See the Instructions for Form 5713 for a list of boycotting countries. Column (2). Enter the principal business activity code of the boycott operation from the list in the Instructions for Form 5713.

Column (3). Briefly describe the principal business activity of the boycott operation. For IC-DISCs, enter the major product code and description in parentheses. See the Instructions for Schedule N of Form 1120-IC-DISC for a list of the codes. Column (4). Enter the foreign taxes paid, accrued, or deemed paid that are attributable to the boycott operation. These taxes are not eligible for the foreign tax credit. Omit foreign taxes otherwise disallowed under sections 901 through 907, 911, and 6038. For more information, see Part N of the Treasury Department’s International Boycott Guidelines.

Enter the column (4) total on line 2b, Schedule C (Form 5713).

Column (5). Enter your prorated share of the controlled foreign corporation’s income that is attributable to the boycott operation. (This includes your share of the non-exempt income of a FSC. See section 923(a)(2), as in effect before its repeal.) This amount is not eligible for tax deferral. Omit the foreign corporation’s income attributable to earnings and profits that are included in gross income under section 951 (except by reason of section 952(a)(3)). Also omit amounts excluded from subpart F income by section 952(b). In figuring the amount to enter in column (5), you are allowed a reasonable amount for deductions (including foreign taxes) allocable to that income.

Enter the column (5) total on line 3b, Schedule C (Form 5713). Column (6). An IC-DISC’s taxable income attributable to boycott participation or cooperation is not eligible for deferral.

If you are a shareholder in an IC-DISC, follow these steps for each boycott operation and enter the result in column (6).

1. Determine the portion of the amount on Form 1120-IC-DISC, Schedule J, Part I, line 7, that is attributable to the boycott operation.

2. Subtract that amount from the IC-DISC’s taxable income attributable to the boycott operation for the tax year, before reduction for any distributions.

3. If you are a C corporation, determine your pro rata share of the remainder and multiply that amount by 16/17. If you are not a C corporation, determine your pro rata share of the remainder.

4. Enter the result in column (6). Enter the column (6) total on line 4b,

Schedule C (Form 5713). Column (7). A FSC’s taxable income attributable to boycott participation or cooperation is not eligible for exemption from income tax. Enter in column (7) the taxable income attributable to foreign trade income of a FSC for each boycott operation that would have been exempt had there not been boycott participation or cooperation.

Enter the column (7) total on line 5b, Schedule C (Form 5713).


SCHEDULE C (Form 5713) (Rev. December 2010)


Tax Effect of the International Boycott Provisions ▶ Attach to Form 5713.

▶ See instructions on page 2.

OMB No. 1545-0216


1 Method used to compute loss of tax benefits (check one): a International boycott factor from Schedule A (Form 5713). See lines 2a, 3a, 4a, and 5a below . . . . . . . . . ▶

b Identification of specifically attributable taxes and income from Schedule B (Form 5713). See lines 2b, 3b, 4b, and 5b below . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

2 Reduction of foreign tax credit (section 908(a)): a International boycott factor. Complete if you checked box 1a above and answered “Yes” to the

question on line 7d, Form 5713. (1) Foreign tax credit before adjustment from Form 1116 or 1118 (see instructions) . . . . . .(2) International boycott factor from Schedule A (Form 5713), line 3 . . . . . . . . . . .(3) Reduction of foreign tax credit. Multiply line 2a(1) by line 2a(2). Enter here and on Form 1116 or

1118 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . (4) Adjusted foreign tax credit. Subtract line 2a(3) from line 2a(1) . . . . . . . . . . . .

b Specifically attributable taxes and income. Complete if you checked box 1b above and answered “Yes” to the question on line 7d, Form 5713. Enter the amount from line o, column (4), Schedule B (Form 5713) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enter the appropriate part of this amount on Form 1116 or 1118 (see instructions).

3 Denial of deferral under subpart F (section 952(a)(3)): a International boycott factor. Complete if you checked box 1a above and answered ‘‘Yes’’ to the

question on line 7b, Form 5713. (1) Prorated share of total income of controlled foreign corporations (see instructions) . . . . .(2) Prorated share of income attributable to earnings and profits of controlled foreign corporations

included in income under sections 951(a)(1)(A)(ii), 951(a)(1)(A)(iii), 951(a)(1)(B), 952(a)(1), 952(a)(2), 952(a)(4), 952(a)(5), and 952(b) . . . . . . . . . . . . . . . . . . .

(3) Subtract line 3a(2) from line 3a(1) . . . . . . . . . . . . . . . . . . . . .(4) International boycott factor from Schedule A (Form 5713), line 3 . . . . . . . . . . .(5) Prorated share of subpart F international boycott income. Multiply line 3a(3) by line 3a(4). Enter

here and on line 22 of Worksheet A in the Form 5471 instructions . . . . . . . . . .b Specifically attributable taxes and income. Complete if you checked box 1b above and answered

“Yes” to the question on line 7b, Form 5713. Enter the amount from line o, column (5), Schedule B (Form 5713) here and on line 22 of Worksheet A in the Form 5471 instructions . . . . . . . .

4 Denial of IC-DISC benefits (section 995(b)(1)(F)(ii)): a International boycott factor. Complete if you checked box 1a above and answered “Yes” to the

question on line 7c, Form 5713. (1) Prorated share of section 995(b)(1)(F)(i) amount (see instructions) . . . . . . . . . . . (2) International boycott factor from Schedule A (Form 5713), line 3 . . . . . . . . . . .(3) Prorated share of IC-DISC international boycott income. Multiply line 4a(1) by line 4a(2). Enter this

amount here and the IC-DISC will include it on line 10, Part I, Schedule J, Form 1120-IC-DISC . .b Specifically attributable taxes and income. Complete if you checked box 1b above and answered

“Yes” to the question on line 7c, Form 5713. Enter the amount from line o, column (6), Schedule B (Form 5713) here and the IC-DISC will include it on line 10, Part I, Schedule J, Form 1120-IC-DISC

5 Denial of exemption of foreign trade income (section 927(e)(2), as in effect before its repeal): a International boycott factor. Complete if you checked box 1a above and answered “Yes” to the

question on line 7i, Form 5713. (1) Add amounts from columns (a) and (b), line 10, Schedule B (Form 1120-FSC) . . . . . .(2) International boycott factor from Schedule A (Form 5713), line 3 . . . . . . . . . . .(3) Exempt foreign trade income of a FSC attributable to international boycott operations. Multiply

line 5a(1) by line 5a(2). Enter here and on line 2, Schedule F, Form 1120-FSC . . . . . . .b Specifically attributable taxes and income. Complete if you checked box 1b above and answered

“Yes” to the question on line 7i, Form 5713. Enter the amount from line o, column (7), Schedule B (Form 5713) here and on line 2, Schedule F, Form 1120-FSC . . . . . . . . . . . . . .

For Paperwork Reduction Act Notice, see Instructions for Form 5713. Cat. No. 12070O Schedule C (Form 5713) (Rev. 12-2010)


Schedule C (Form 5713) (Rev. 12-2010) Page 2 6 Reduction of foreign trade income qualifying for the extraterritorial income exclusion. Complete if you

answered “Yes” to the question on line 7j, Form 5713. a Enter amount from line 49 of Form 8873 . . . . . . . . . . . . . . . . . . . . .b International boycott factor from Schedule A (Form 5713), line 3 . . . . . . . . . . . . .c Reduction of qualifying foreign trade income. Multiply line 6a by 6b. Enter here and on Form 8873,

line 50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Instructions Section references are to the Internal Revenue Code unless otherwise noted.

Purpose of Form Schedule C (Form 5713) is used to compute the loss of tax benefits attributable to participation in or cooperation with an international boycott.

Who Must File Complete Schedule C (Form 5713) if you completed either Schedule A or Schedule B of Form 5713. Partnerships. Each partner must complete a separate Schedule C (Form 5713). Partnerships do not complete Schedule C (Form 5713). Controlled groups. Unless a controlled group (described in section 993(a)(3)) files a consolidated return, each member may independently choose to either (a) apply the international boycott factor under section 999(c)(1) or (b) identify specifically attributable taxes and income under section 999(c)(2). Each member must consistently use a single method to figure the loss of tax benefits.

Example. A member that chooses to use the international boycott factor must apply it to determine its loss of the section 902 indirect foreign tax credit on a dividend that another member of the controlled group paid to it, even if the other member determines its own loss of tax benefits

by identifying specifically attributable taxes and income.

Other Requirements • A person who applies the international boycott factor to one operation must apply the factor to all that tax year’s operations under section 908(a), 952(a)(3), 995(b)(1)(F)(ii), or 927(e)(2). • A person who identifies specifically attributable taxes and income under section 999(c)(2) must use that method for all that tax year’s operations under section 908(a), 952(a)(3), 995(b)(1)(F)(ii), or 927(e)(2). • An IC-DISC whose tax year differs from the common tax year of the controlled group of which it is a member does not need to amend its return to show on Schedule J (Form 1120-IC-DISC) the amount of IC-DISC benefits lost because of boycott participation. Because the IC-DISC benefits are lost at the shareholder level, the shareholder must include in income the prorated share of income attributable to boycott operations shown on line 4a(3). • A person excluding extraterritorial income must reduce qualifying foreign trade income using the international boycott factor computed on Schedule A.

Lines 2 through 6 Note. All line references are to 2010 forms unless otherwise noted. Line 2a(1). Enter the foreign tax credit before adjustment from Form 1116 or 1118. Individual filers, enter the

amount from line 27, Part IV, of Form 1116. Corporate filers, enter the amount from line 4, Part III, Schedule B, of Form 1118. Line 2a(3). Enter the reduction of foreign tax credit from this line on either Form 1116 or 1118. Individual filers, enter this amount on line 28, Part IV, of Form 1116. Corporate filers, enter this amount on line 5, Part III, Schedule B, of Form 1118. Line 2b. Enter the reduction of foreign taxes available for credit from this line on Form 1116 or 1118. Individual filers, include this amount on line 12, Part III, of Form 1116. Corporations, enter this amount on line C, Schedule G, of Form 1118. Line 3a(1). Enter your share of the income of the controlled foreign corporation on line 3a(1).

Nonexempt foreign trade income of a foreign sales corporation (FSC) that was computed without regard to the administrative pricing rules is subject to the subpart F rules. Include your share of these types of income on line 3a(1). Line 4a(1). Enter your pro rata share of section 995(b)(1)(F)(i) amount on line 4a(1) as follows: • Shareholder that is not a C corporation. Enter your pro rata share of line 8, Part I, Schedule J, Form 1120-IC-DISC. • Shareholder that is a C corporation. Enter your pro rata share of line 8, Part I, Schedule J, Form 1120-IC-DISC, multiplied by 16/17.

Schedule C (Form 5713) (Rev. 12-2010)


Withholding agent’s name, street address, city, state, and ZIP code

Date of transfer

1 Statement of Withholding on

Dispositions by Foreign Personsof U.S. Real Property Interests

Federal income tax withheld

2

OMB No. 1545-0902

Withholding agent’s Federalidentification number

Identification number of foreign personsubject to withholding (see instructions)

Gain recognized by foreigncorporation

4

Amount realized

3

Copy A For Internal

RevenueService Center

Description of property transferred

5

Name of person subject to withholding

For Privacy Actand PaperworkReduction Act

Notice, see theinstructions for

Form 8288.

An individual

6

Person subject to withholding is:

Foreign address (number, street, and apt. or suite no.) Other (specify) �

A corporation City, province or state, postal code, and country (not U.S.)

Mailing address of person subject to withholding (if different)

Attach Copies A and B to Form 8288

Department of the Treasury - Internal Revenue Service

Form 8288-A (Rev. 11-2006)

Cat. No. 62261L


Interest Charge on DISC-RelatedDeferred Tax Liability

Form

8404

OMB No. 1545-0939


� File Form 8404 separately from your income tax return. See Where to file below. B

Shareholder’s identifyingnumber

Name of shareholder

A

Check applicable box toshow type of taxpayer:

Address (number, street, room, suite, or P.O. box number) Corporation

C

IC-DISC’s identifyingnumber

Individual City, state, and ZIP code Trust or

Decedent’s estate E

Name of IC-DISC

D

Shareholder’s tax year for which interest charge is required to be paid (see instructions)

1

1

Taxable income or loss on tax return (actual or estimated) 2

2

Deferred DISC income from line 10, Part III, Schedule K (Form 1120-IC-DISC) 3

3

Section 995(f)(2) adjustments to line 1 income or loss 4

4

Combine lines 1, 2, and 3. If zero or less, do not file this form 5

5

Tax liability on line 4 amount 6

6

Tax liability per return (actual or estimated) 7

7

DISC-related deferred tax liability. Subtract line 6 from line 5 8

Base period T-bill rate factor

8 9

9

Interest charge due. Multiply line 7 by line 8. (See Paying the interest charge below.) Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge

and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Sign

Here � Date

Signature and Title (if any)

Date

Check if self-employed �



Firm’s name (or yours ifself-employed), address,and ZIP code

EIN Phone no.

For example, you are a fiscal yearcorporation with a July 1, 2008, to June 30,2009, tax year and you are a shareholder inan IC-DISC with a July 1, 2008, to June 30,2009, tax year that reports deferred DISCincome to you for its tax year ending June 30,2009. Because your tax year ends with theIC-DISC’s tax year, you are required to fileForm 8404 on or before September 15, 2009(21⁄2 months after your tax year ends).

General Instructions Section references are to the Internal RevenueCode unless otherwise noted. Purpose of form. Shareholders of InterestCharge Domestic International SalesCorporations (IC-DISCs) use Form 8404 tofigure and report their interest owed onDISC-related deferred tax liability. Who must file. You must file Form 8404 if:(a) you are a shareholder of an IC-DISC; (b) the IC-DISC reports deferred DISC incometo you on line 10, Part III of Schedule K(Form 1120-IC-DISC); and (c) the addition ofthis income would result in increased taxableincome if it were included on your tax returnfor the tax year. When to file. File Form 8404 by the due dateof your federal income tax return (excludingextensions) for your tax year that ends with orincludes the IC-DISC’s tax year end.

Attach a check or money order madepayable to “United States Treasury” for thefull amount of the interest charge. Do notcombine the interest charge with any othertax or interest due. Write your identificationnumber and “Form 8404—Interest Due” onyour payment. Do not use Form 8109, FederalTax Deposit Coupon.

Form 8404 (2008)

Cat. No. 62423Z

� �

�

If the interest charge is not paid by the duedate, interest, compounded daily, at the ratespecified under section 6621, will be imposedon the amount of unpaid interest from thedue date until the date the interest is paid.

Specific Instructions Name and address. Enter the name andaddress as shown on your tax return fromwhich the income or loss on line 1 of Form8404 is obtained. If the return is a joint return,also enter your spouse’s name as shown onForm 1040.


( )

For corporations (other than Scorporations), the annual interest charge isdeductible as an interest expense for the taxyear it is paid or accrued. See ProposedRegulations section 1.995(f)-1(j)(2) for detailson the tax year of deductibility. For otherfilers, this interest is not deductible.

Note. See line-by-line instructions.

For Privacy Act and Paperwork Reduction Act Notice, see page 2.

Payment of estimated tax is not requiredfor the interest charge. See ProposedRegulations section 1.995(f)-1(j)(3) for otherdetails.

changes you make by the filing of anamended return, or if estimates were used onyour original Form 8404 and changes weremade to these estimates when you filed yourtax return. See Proposed Regulations section1.995(f)-1(j)(4) for details.

08

Paying the interest charge. You must paythe interest charge shown on line 9 by thedate your federal income tax for the tax yearis required to be paid. For individuals, theinterest is due on the 15th day of the 4thmonth following the close of the tax year. Forcorporations, the interest is due on the 15thday of the 3rd month following the close ofthe tax year.

Where to file. File Form 8404 at the followingaddress:

Department of the TreasuryInternal Revenue ServiceCincinnati, OH 45999

Amended Form 8404. You are required to filean amended Form 8404 only if the amount ofthe DISC-related deferred tax liability (line 7)changes as a result of audit adjustments,

Item B—Shareholder’s identifying number.Individuals must enter their social securitynumber. Other filers must enter their employeridentification number.

Partnerships and S corporations distributetheir share of deferred DISC income topartners and shareholders and the partnersand shareholders complete Form 8404.

Item C—IC-DISC’s Identifying number.Enter the identifying number of the IC-DISCfrom the Schedule K (Form 1120-IC-DISC) onwhich the deferred DISC income wasreported to you. If income is reported to youfrom more than one IC-DISC, enter eachIC-DISC’s identifying number in item C, eachIC-DISC’s name in item E, and report thecombined income on line 2.

Item A—Type of taxpayer. Check theapplicable box to indicate your status as ataxpayer.


Page 2 Form 8404 (2008)

Note. If the tax year is the last tax year towhich the amount of carryforward (of loss,deduction, or credit) may be carried, the line3 adjustments and line 5 tax shall be figuredwith regard to the full amount of suchcarryforward.

The following taxes are not taken intoaccount: ● Alternative minimum tax.

● Any other provisions described in section26(b)(2) (relating to certain other taxes treatedas not imposed by Chapter 1). The following credits are not taken intoaccount: ● Section 31 (taxes withheld on wages).

● Section 32 (earned income credit). ● Section 34 (fuels credit).

Other adjustments. In figuring line 3adjustments, take into account any incomeand expense adjustments that do not result inamounts that may be carried back or forwardto other tax years. For example, in the caseof an IC-DISC shareholder who is anindividual, the amount of medical expensesallowable as a deduction under section 213must be redetermined for purposes of line 3adjustments. However, the amount allowableas a charitable deduction under section 170is not redetermined because this adjustmentcould result in a carryback or carryover. See Proposed Regulations section1.995(f)-1(d) for other details regarding theseand other special computation rules.

Line 8. The base period T-bill rate is definedin section 995(f)(4). The base period T-bill rateis compounded daily based on the number ofdays in the shareholder’s tax year todetermine the base period T-bill rate factor. The base period T-bill rate factor for 2008is .025039760 for a 365-day tax year and.025109217 for a 366-day tax year. Enter theappropriate factor on line 8 of Form 8404.See Rev. Rul. 2008-51, 2008-47 I.R.B. 1171,for a short tax year or a 52-53 week tax year.

Special Computation Rules Carrybacks. The determination of theshareholder’s DISC-related deferred taxliability on lines 1 through 7 shall be madewithout taking into account any net operatingloss (NOL), capital loss carryback, or creditcarryback to the tax year.

Lines 5 and 6. “Tax liability” on lines 5 and 6(with and without the deferred DISC income)means the amount of tax imposed on theIC-DISC shareholder for the tax year byChapter 1 of the Internal Revenue Code(other than taxes listed below) reduced bycredits allowable against such tax (other thancredits listed below).

Carryovers. The determination of theshareholder’s tax liability (line 5) for the taxyear is made by disregarding any loss,deduction, or credit to the extent that suchloss, deduction, or credit may be carried(either back or forward) by the shareholder toany other tax year.

See Special Computation Rules above forrules for carrybacks and carryovers. Theserules may affect the line 5 computation.

For 2008, a Form 1040 filer or a Form 1120filer using the above rules will generally figuretheir line 6 tax liability using the followingitems shown on the following lines of thoseforms. All other filers should use thecorresponding lines of other income taxreturns. If you have not yet filed your return,estimate the line 6 tax liability based on allinformation available to you.

Tax less nonrefundablecredits

Plus: (1)Advance earnedincome creditpayments

(2)Recapture taxes(except Form 8828)

Less: (1) Alternative minimum tax

2008Form 1040

Line

56

60a *

45

2008Form 1120

Line

7, Sch. J

3, Sch. J

For example, a shareholder had a NOLcarryover to 2009 of $12,000; $10,000 incometo which $10,000 of the NOL can be applied;$2,000 allowable NOL carryover to 2010; and$5,000 deferred DISC income for 2009. In thiscase, for purposes of figuring line 5, theallowed NOL is $10,000. Note. If 2009 werethe last tax year to which the $12,000 NOLcould be carried, the full $12,000 NOL wouldbe allowed for purposes of figuring line 5 taxliability. The additional $2,000 loss would beentered on line 3.

Privacy Act and Paperwork Reduction ActNotice. We ask for the information on thisform to carry out the Internal Revenue laws ofthe United States. We need it to figure andcollect the right amount of tax. Section 995(f)requires taxpayers to pay over to the IRSinterest on DISC-Related Deferred TaxLiability. This form is used to determine theamount of tax that you owe. Sections 6001and 6011 require you to provide therequested information if the tax applies toyou. Section 6109 requires you to provideyour social security number or otheridentifying number. Routine uses of thisinformation include disclosing it to theDepartment of Justice for civil and criminallitigation and to other federal agencies, asprovided by law. We may disclose theinformation to cities, states, the District ofColumbia, and U.S. Commonwealths orpossessions to administer their tax laws. Wemay disclose the information to foreigngovernments pursuant to tax treaties. Wemay disclose the information to theDepartment of the Treasury and contractorsfor tax administration purposes. We may alsodisclose this information to other countriesunder a tax treaty, to federal and stateagencies to enforce federal nontax criminallaws, or to federal law enforcement andintelligence agencies to combat terrorism. Ifyou do not file this information required bylaw or provide incomplete or fraudulentinformation, you may be subject to interest,penalties, and/or criminal prosecution.

The time needed to complete and file thisform will vary depending on individualcircumstances. The estimated average timeis:

If you have comments concerning theaccuracy of these time estimates orsuggestions for making this form simpler, wewould be happy to hear from you. You canwrite to the Internal Revenue Service, TaxProducts Coordinating Committee,SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave.NW, IR-6526, Washington, DC 20224.

You are not required to provide theinformation requested on a form that issubject to the Paperwork Reduction Actunless the form displays a valid OMB controlnumber. Books or records relating to a formor its instructions must be retained as long astheir contents may become material in theadministration of any Internal Revenue law.Generally, tax returns and return informationare confidential, as required by section 6103.

Recordkeeping 4 hr., 4 min. Learning about the

law or the form 2 hr., 17 min. Preparing, copying

and sending the form to the IRS 2 hr., 27 min.

Do not send the form to this office. Instead,see Where to file on page 1.

(3)Prior year minimumtax credit

54b

5d, Sch. J

(3) Credit for tax paid onundistributed capitalgains (Form 2439)

68a

32f, pg. 1

*Caution: Only use the portion of Form 1040,line 61, or Form 1120, Schedule J, line 9,attributable to recapture of credits allowableagainst taxes treated as imposed underChapter 1 (e.g., recapture of investment taxand low-income housing credits).

(2) Additional child taxcredit

66

(4) Health insurancecredit for eligiblerecipients (Form8885)

68d

*

Item D—Tax year. Enter in item D thecalendar year or the beginning and endingdates of the tax year shown on your taxreturn for which the interest charge is figured.

Line-by-Line Instructions Line 1. Enter on line 1 the taxable income orloss from your federal income tax return foryour tax year that ends with or includes theIC-DISC’s tax year end. If you have not yetfiled your tax return, estimate your income orloss based on all information available to you.See Amended Form 8404 on page 1.

Line 2. Enter the deferred DISC income fromline 10, Part III of Schedule K (Form1120-IC-DISC), for the IC-DISC tax year thatends with or within your tax year. Line 3. Enter the net amount of all section995(f)(2) adjustments to taxable income. SeeSpecial Computation Rules above for detailson the income (loss) and expenseadjustments to be made. If more than oneadjustment is involved, attach a schedulelisting each item and show the computationof the net amount.



Foreign Partner's Information Statement of Section 1446 Withholding Tax

� See separate Instructions for Forms 8804, 8805, and 8813.For partnership’s calendar year 2010, or tax year beginning , 2010, and ending , 20

OMB No. 1545-1119

2010Copy A for Internal Revenue Service

Attach to Form 8804.

1a Foreign partner’s name b U.S. identifying number

c Address (if a foreign address, see instructions)

2 Account number assigned by partnership (if any)

3 Type of partner (specify—see instructions) �

4 Country code of partner (enter two-letter code; see instructions)

5a Name of partnership b U.S. EIN


6 Withholding agent’s name. If partnership is also the withholding agent, enter “SAME” and do not complete line 7.

7 Withholding agent’s U.S. employer identification number

8a Check if the partnership identified on line 5a owns an interest in one or more partnerships . . . . . . . . . . . . . .b Check if any of the partnership’s effectively connected taxable income (ECTI) is exempt from U.S. tax for the partner identified on line 1a .

9 Partnership’s ECTI allocable to partner for the tax year (see instructions) . . . . . . . . . . . 9

10 Total tax credit allowed to partner under section 1446 (see instructions). Individual and corporate partners: Claim this amount as a credit against your U.S. income tax on Form 1040NR, 1120-F, etc. . . . . . 10

Schedule T—Beneficiary Information (see instructions)11a Name of beneficiary

b U.S. identifying number of beneficiary


12 Amount of ECTI on line 9 to be included in the beneficiary’s gross income (see instructions) . . . . . 12

13 Amount of tax credit on line 10 that the beneficiary is entitled to claim on its return (see instructions) . . 13

For Paperwork Reduction Act Notice, see separate Instructions for Forms 8804, 8805, and 8813. Cat. No. 10078E Form 8805 (2010)


Form 8832 (Rev. February 2010) Department of the Treasury Internal Revenue Service

Entity Classification Election OMB No. 1545-1516

Type or

Print

N e of eligible entity making election Employer id tification number


City or town, state, and ZIP code. If a foreign address, enter city, province or state, postal code and country. Follow the country’s practice for entering the postal code.

� Check if: Address change

1 Type of election (see instructions):

a Initial classification by a newly-formed entity. Skip lines 2a and 2b and go to line 3. b Change in current classification. Go to line 2a.

2 a Has the eligible entity previously filed an entity election that had an effective date within the last 60 months?

Yes. Go to line 2b. No. Skip line 2b and go to line 3.

2 b Was the eligible entity’s prior election for initial classification by a newly formed entity effective on the date of formation?

Yes. Go to line 3. No. Stop here. You generally are not currently eligible to make the election (see instructions).

3 Does the eligible entity have more than one owner?

Yes. You can elect to be classified as a partnership or an association taxable as a corporation. Skip line 4 and go to line 5.

No. You can elect to be classified as an association taxable as a corporation or disregarded as a separate entity. Go to line 4.

4 If the eligible entity has only one owner, provide the following information: a Name of owner �b Identifying number of owner �

5 If the eligible entity is owned by one or more affiliated corporations that file a consolidated return, provide the name and employer identification number of the parent corporation:

a Name of parent corporation � b Employer identification number �

For Paperwork Reduction Act Notice, see instructions. Cat. No. 22598R Form 8832 (Rev. 2-2010)


Form 8832 (Rev. 2-2010) Page 2 6 Type of entity (see instructions):

a A domestic eligible entity electing to be classified as an association taxable as a corporation. b A domestic eligible entity electing to be classified as a partnership. c A domestic eligible entity with a single owner electing to be disregarded as a separate entity. d A foreign eligible entity electing to be classified as an association taxable as a corporation. e A foreign eligible entity electing to be classified as a partnership. f A foreign eligible entity with a single owner electing to be disregarded as a separate entity.

7 If the eligible entity is created or organized in a foreign jurisdiction, provide the foreign country of organization �

8 Election is to be effective beginning (month, day, year) (see instructions) . . . . . . . . . . . . �

9 Name and title of contact person whom the IRS may call for more information 10 Contact person’s telephone number

Consent Statement and Signature(s) (see instructions)

Under penalties of perjury, I (we) declare that I (we) consent to the election of the above-named entity to be classified as indicated above, and that I (we) have examined this consent statement, and to the best of my (our) knowledge and belief, it is true, correct, and complete. If I am an officer, manager, or member signing for all members of the entity, I further declare that I am authorized to execute this consent statement on their behalf.

Signature(s) Date Title

Form 8832 (Rev. 2-2010)


OMB No. 1545-1910

Information Return of U.S. Persons With Respect To Foreign Disregarded Entities

8858 Form

(Rev. December 2007) Information furnished for the foreign disregarded entity’s annual accounting period (see

instructions) beginning . . . , 20 , and ending , 20

Department of the TreasuryInternal Revenue Service Name of person filing this return

Filer’s identifying number

Number, street, and room or suite no. (or P.O. box number if mail is not delivered to street address)


Filer’s tax year beginning , 20 , and ending , 20 Important: Fill in all applicable lines and schedules. All information must be in English. All amounts must be stated

in U.S. dollars unless otherwise indicated. b

U.S. identifying number, if any

Name and address of foreign disregarded entity

1a

Effective date as foreigndisregarded entity

e

Functional currency

h

Country in which principalbusiness activity is conducted

g

If benefits under a U.S. tax treaty were claimed with respect toincome of the foreign disregarded entity, enter the treaty and articlenumber

a

2

Provide the following information for the foreign disregarded entity’s accounting period stated above. b

Name, address, and identifying number of branch office or agent (if any) inthe United States

For Paperwork Reduction Act Notice, see the separate instructions. Form 8858 (Rev. 12-2007)


Cat. No. 21457L

f

Principal businessactivity

i

Country(ies) under whose laws organized and entity type under local tax law

c

Name and address (including corporate department, if applicable) ofperson(s) with custody of the books and records of the foreign disregardedentity, and the location of such books and records, if different

a

3

For the tax owner of the foreign disregarded entity (if different from the filer) provide the following: b

Name and address

Annual accounting period covered by thereturn (see instructions)

a

4

For the direct owner of the foreign disregarded entity (if different from the tax owner) provide the following: b

Name and address

Country under whose laws organized

c

Functional currency

e

d

Country under whose laws organized

c

Functional currency

d

5

Attach an organizational chart that identifies the name, placement, percentage of ownership, tax classification, and country of organization of all entities inthe chain of ownership between the tax owner and the foreign disregarded entity, and the chain of ownership between the foreign disregarded entity andeach entity in which the foreign disregarded entity has a 10% or more direct or indirect interest. See instructions.

Important: Report all information in functional currency in accordance with U.S. GAAP. Also, report each amount inU.S. dollars translated from functional currency (using GAAP translation rules or the average exchange rate determined under section 989(b)). If the functional currency is the U.S. dollar, complete only the U.S. Dollars column. See instructions for special rules for foreign disregarded entities that use DASTM. If you are using the average exchange rate (determined under section 989(b)), check the following box

Income Statement (see instructions)

Gross receipts or sales (net of returns and allowances)

1 1 2 Cost of goods sold

2

3 Gross profit (subtract line 2 from line 1)

3 4 Other income

4

5 Total income (add lines 3 and 4)

5 6 Total deductions

6

7 Other adjustments

7 8 Net income (loss) per books

8

Schedule C

Functional Currency

U.S. Dollars



Date(s) of organization

d


■ ■

■ ■


Page 2 Form 8858 (Rev. 12-2007)

Section 987 Gain or Loss Information

Remittances from the foreign disregarded entity

1 1 2 Section 987 gain (loss) of recipient

2

Were all remittances from the foreign disregarded entity treated as made to the direct owner?

3 Did the tax owner change its method of accounting for section 987 gain or loss with respect toremittances from the foreign disregarded entity during the tax year?

4

Schedule C-1 (a)

Amount stated infunctional currency of

foreign disregarded entity

(b)Amount stated in

functional currencyof recipient

Form 8858 (Rev. 12-2007)

Yes

No

Balance Sheet

(b)End of annual

accounting period

(a)Beginning of annualaccounting period

Assets

1 Cash and other current assets

1 2 Other assets

2

3 3

4 4 5 5 6

Total assets

6

Liabilities Owner’s equity

Total liabilities and owner’s equity

Liabilities and Owner’s Equity

Schedule F Important: Report all amounts in U.S. dollars computed in functional currency and translated into U.S. dollars in

accordance with U.S. GAAP. See instructions for an exception for foreign disregarded entities that use DASTM.

1 Current year net income or (loss) per foreign books of account Total net additions

2

Total net subtractions

3 Current earnings and profits (or taxable income—see instructions) (line 1 plus line 2 minus line 3)

4

Current earnings and profits (or taxable income) in U.S. dollars (line 6 translated at the averageexchange rate determined under section 989(b) and the related regulations (see instructions))

Schedule H

6

Current Earnings and Profits or Taxable Income (see instructions) Important: Enter the amounts on lines 1 through 6 in functional currency.

Other Information Schedule G

During the tax year, did the foreign disregarded entity own an interest in any trust? During the tax year, did the foreign disregarded entity own at least a 10% interest, directly or indirectly,

in any foreign partnership?

1 2

3

Yes

No

Answer the following question only if the foreign disregarded entity made its election to be treated asdisregarded from its owner during the tax year: Did the tax owner claim a loss with respect to stock ordebt of the foreign disregarded entity as a result of the election?

4 Answer the following question only if the foreign disregarded entity is owned directly or indirectly by adomestic corporation and the foreign disregarded entity incurred a net operating loss for the tax year: Is the foreign disregarded entity a separate unit as defined in Regulations sections 1.1503-2(c)(3) and (4) or1.1503(d)-1(b)(4)? (If “Yes,” see the instructions)

5 Answer the following question only if the tax owner of the foreign disregarded entity is a controlled foreigncorporation (CFC): Were there any intracompany transactions between the foreign disregarded entity andthe CFC or any other branch of the CFC during the tax year, in which the foreign disregarded entity actedas a manufacturing, selling, or purchasing branch?

7 Combine lines 4 and 5

Enter exchange rate used for line 7 �

1 2 3 4

6

7

5 DASTM gain or loss (if applicable)

5

Consolidation Code

Inactive Code

Schedule M Code

Schedule 987 Code


OMB No. 1545-1910

Transactions Between Foreign Disregarded Entity of aForeign Tax Owner and the Filer or Other Related Entities

SCHEDULE M(Form 8858)(December 2004)Department of the TreasuryInternal Revenue Service

Name of person filing Form 8858 Identifying number

Name of foreign disregarded entity

Important: Complete a separate Schedule M for each foreign disregarded entity for which the tax owner is a controlled foreigncorporation or controlled foreign partnership. Enter the totals for each type of transaction that occurred during the annual accountingperiod between the foreign disregarded entity and the persons listed in the applicable columns (b) through (f). All amounts must bestated in U.S. dollars translated from functional currency at the appropriate exchange rate for the foreign disregarded entity’s taxyear (see instructions).

For Paperwork Reduction Act Notice, see the Instructions for Form 8858. Schedule M (Form 8858) (12-2004)

� Attach to Form 8858. � See separate instructions.

Cat. No. 37387C

Name of tax owner

1

2

3

4

5

6

789

10

11

12

13

14

15

1617

18

19

Sales of inventory

Sales of property rights

Compensation received forcertain services

Commissions received

Rents, royalties, and licensefees received

Dividends/Distributionsreceived

Interest receivedOther Add lines 1 through 8

Purchases of inventory

Purchases of tangible prop-erty other than inventory

Purchases of property rights

Compensation paid for certainservices

Commissions paid

Rents, royalties, and licensefees paidInterest paidAdd lines 10 through 16

Amounts borrowed (seeinstructions)Amounts loaned (seeinstructions)

Enter the relevant functional currency and the exchange rate used throughout this schedule �

(b) U.S. person filingthis return


partnershipcontrolling or

controlled by the filer

(d) Any foreigncorporation or

partnershipcontrolling or

controlled by the filer (other than the

tax owner)

(e) Any U.S. personwith a 10% or moredirect interest in the

controlled foreignpartnership (other

than the filer)

Controlled Foreign Partnership

(b) U.S. person filingthis return


partnership controlledby the filer

(d) Any foreigncorporation or

partnership controlledby the filer (otherthan tax owner)

(e) 10% or more U.S.shareholder of any

corporationcontrolling the tax

owner

Controlled Foreign Corporation (f) 10% or more U.S.shareholder, or otherowner, of any entitycontrolling the tax

owner

(a) Transactions offoreign disregarded

entity

(a) Transactions offoreign disregarded

entity

Column Headings. This schedule contains two sets of column headings. Check the box that identifies the status of the taxowner and complete lines 1 through 19 with respect to the applicable set of column headings:

■

367


Changes to Corporation Statistics Branch Programs

Form 1120, U.S. Corporation Income Tax Return

Page 4, Schedule K, new line 14 will be edited. This line refers to the corporation’s requirement to file Schedule UTP.

Form 1120, Schedule D, Capital Gains and Losses

Part IV, Alternative Tax for Corporations with Qualified Timber Gains, was deleted from the form. We also will not pick up part IV on 2009 revision returns.

Form 1120, Schedule M-3

New Lines 35 and 36 on Page 3, Part III will be edited. Line 35 requires the filer to enter research and development costs. Line 36 requires the filer to enter the amounts of Section 118 exclusion. Former lines 35 and 36 are now lines 37 and 38.

Form 1120, Schedule UTP, Uncertain Tax Position Statement

This new schedule UTP (Form 1120) for tax year 2010 will be filed by filers with total assets in excess of $10 million to gather information regarding these entities in uncertain tax positions. We will pick up information from Part I for a specified number of tax positions. This form can be filed with Forms 1120, 1120-F, 1120-L, and 1120-PC.

Form 1120-F, U.S. Income Tax Return of a Foreign Corporation

Page 1, Computation of Tax Due or Overpayment, line 8 was split into lines 8a and 8b. The line was split to show the total overpayment that is attributable to tax deducted and withheld under Chapter 3 on Line 8b. Line 8b will be edited.

Page 2, Additional Information, new line AA will be edited. This line refers to the corporation’s re-quirement to file Schedule UTP.

Page 6, Schedule L, we will pick up the checkbox that shows whether the balance sheet was complet-ed on U.S. basis or Worldwide basis.

Form 1120-F, Schedule M-3

We will pick up all lines and all columns for the 2010 program.

Form 1120-L, U.S. Life Insurance Company Income Tax Return

Schedule M, new line 15 will be edited. This line refers to the corporation’s requirement to file Schedule UTP.

368



Form 1120-L, Schedule M-3


Form 1120-PC, U.S. Property and Casualty Insurance Company Income Tax Return

Page 6, Schedule H, Lines 1–3b were added to capture information related to the Public Health Ser-vice Act. We do not plan to edit these lines. Subsequent lines were renumbered.

Page 7, Schedule I, new line 13 will be edited. This line refers to the corporation’s requirement to file Schedule UTP.

Form 1120-PC, Schedule M-3


Form 1120S, U.S. Income Tax Return for an S Corporation

Page 2, Schedule B, new line 9 will be edited. The S corporation uses this line to report that a quali-fied subchapter S subsidiary election was terminated or revoked.

Form 1120S, Schedule M-3


Form 1118

As with Tax Year 2009, a micro-data file from the Special Studies Branch will be sent with each of the Advance and Final corporate data files consisting of totals for each of the following as well as the total passive and general category income amounts: Schedule A (all columns) and Schedule B, lines 1–12. In addition, Schedule B, Part III, Summary, data and Schedule F column totals will also be included.


New line 8, Qualifying therapeutic discovery project credit, will be edited. Subsequent lines were renumbered.

We will also edit line 12s, Qualified investment credit facility property, for the 2010 program.

369




Page 1, Line 1b, welfare to work credit has expired. Line 1b is now reserved for future use.

Page 1, line 1t, credit for Midwestern disaster area employers, has expired. Line 1t is now the new Employer housing credit.

Page 1, line 1aa is no longer needed for the credit for contribution to selected community develop-ment corporations because this credit has expired. New Line 1aa is new hire retention credit (Form 5884-B), which will be edited.

Page 1, credits on lines 1c, 1g, 1l, 1p, 1t, 1u, 1w expired in 2009 and apply in 2010 only to members of certain fiscal year 2009–2010 pass-through entities. The individual credit forms are obsolete, and in most cases members of these pass-through entities will file Form 3800 to obtain these credits.

Page 3, new line 29h for credit for small employer health insurance premiums, from Form 8941, will be edited.

Form 4626, Alternative Minimum Tax—Corporations

Lines 15–24 on Page 2, Part II were deleted since the qualified timber gain is no longer applicable.

Form 6478, Alcohol and Cellulosic Biofuel Fuels Credit

New line 6, for qualified cellulosic biofuel production for fuel sold or used after 2010, will be edited. Subsequent lines were renumbered.

Form 6765, Credit for Increasing Research Activities

This credit expired in 2009 and applies in 2010 only to members of certain fiscal year 2009–2010 pass-through entities, and the form is now obsolete.

Form 8825, Rental Real Estate Income and Expenses of a Partnership or an S Corporation

New line 17, income (loss) from each property, will be generated

Form 8835, Renewable Electricity, Refined Coal, and Indian Coal Production Credit

Line 13 was expanded to lines 13a through 13e. We will edit new lines 13a through 13d. 13e is the equivalent of the former line 13.

Line 14 was expanded to lines 14a through 14g. We will edit new lines 14a through 14f. 14g is the equivalent of the former line 14.

These changes to Lines 13 and 14 are to identify on a separate line electricity produced at qualified facilities using each specific qualified energy resource.

370



Form 8845, Indian Employment Credit

This credit expired in 2009 and applies in 2010 only to members of certain fiscal year 2009–2010 pass-through entities, and the form is now obsolete.

Form 8847, Credit for Contributions to Selected Community Development Corporations

This credit has expired, and the form is now obsolete.

Form 8864, Biodiesel and Renewable Diesel Fuels Credit

Although this credit expired in 2009 and applies in 2010 only to members of certain fiscal year 2009–2010 pass-through entities, Form 8864 is still required to be attached to the tax return.


A column ‘a’ for lines 1 through 10 was added, for amounts related to oil-related production activities. We will pick up line 10a.

New lines 14a, 14b, and 15 were added. Subsequent lines were renumbered. We plan to pick up line 14a.

Form 8910, Alternative Motor Vehicle Credit

We will pick up detail in lines 1 through 10 for up to three vehicles for Tax Year 2010.

Form 8911, Alternative Fuel Vehicle Refueling Property Credit

We will edit lines 1, 2, 3, and 7, columns (a) and (b) for Tax Year 2010.


We will pick up lines 1 through 19 and line 21 from this new form for Tax Year 2010.

372 Corporation Programs


U.S. Corporation Income Tax ReturnFor calendar year 2010 or tax year beginning , 2010, ending , 20


OMB No. 1545-0123

2010Use IRS label. Otherwise, print or type.

Name



A Check if:1a Consolidated return

(attach Form 851) . b Life/nonlife consoli-

dated return . . .2 Personal holding co.

(attach Sch. PH) . .3 Personal service corp.

(see instructions) . .4 Schedule M-3 attached

B Employer identification number

C Date incorporated

D Total assets (see instructions)

$E Check if: (1 Initial return (2) Final return (3) Name change (4) Address change

Inco

me

1a Gross receipts or sales b Less returns and allowances c Bal 1c

2 Cost of goods sold (Schedule A, line 8) . . . . . . . . . . . . . . . . . . . . 2

3 Gross profit. Subtract line 2 from line 1c . . . . . . . . . . . . . . . . . . . . 3

4 Dividends (Schedule C, line 19) . . . . . . . . . . . . . . . . . . . . . . 4

5 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Gross royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 Capital gain net income (attach Schedule D (Form 1120)) . . . . . . . . . . . . . . . 8

9 Net gain or (loss) from Form 4797, Part II, line 17 (attach Form 4797) . . . . . . . . . . . 9

10 Other income (see instructions—attach schedule) . . . . . . . . . . . . . . . . 1011 Total income. Add lines 3 through 10 . . . . . . . . . . . . . . . . . . . . . 11

Ded

ucti

ons

(See

inst

ruct

ions

fo

r lim

itat

ions

on

ded

ucti

ons

.) 12 Compensation of officers (Schedule E, line 4) . . . . . . . . . . . . . . . . . . 12

13 Salaries and wages (less employment credits) . . . . . . . . . . . . . . . . . . 13

14 Repairs and maintenance . . . . . . . . . . . . . . . . . . . . . . . . 14

15 Bad debts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

16 Rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

17 Taxes and licenses . . . . . . . . . . . . . . . . . . . . . . . . . . 17

18 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

19 Charitable contributions . . . . . . . . . . . . . . . . . . . . . . . . . 19

20 Depreciation from Form 4562 not claimed on Schedule A or elsewhere on return (attach Form 4562) . . 20

21 Depletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

22 Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

23 Pension, profit-sharing, etc., plans . . . . . . . . . . . . . . . . . 23

24 Employee benefit programs . . . . . . . . . . . . . . . . . . . . . . 24

25 Domestic production activities deduction (attach Form 8903) . . . . . . . . . . . . . . 25

26 Other deductions (attach schedule) . . . . . . . . . . . . . . . . . . . 26

27 Total deductions. Add lines 12 through 26 . . . . . . . . . . . . . . . . . . . 27

28 Taxable income before net operating loss deduction and special deductions. Subtract line 27 from line 11. 28

29 Less: a Net operating loss deduction (see instructions) . . . . . . . 29a b Special deductions (Schedule C, line 20) . . . . . . . . . 29b 29c

Tax,

Ref

unda

ble

Cre

dits

, and

Pay

men

ts 30 Taxable income. Subtract line 29c from line 28 (see instructions) . . . . . . . . . . . . 30

31 Total tax (Schedule J, line 10) . . . . . . . . . . . . . . . . . . . . . . . 31

32a 2009 overpayment credited to 2010 . 32a

b 2010 estimated tax payments . . . 32b

c 2010 refund applied for on Form 4466 32c ( ) d Bal 32d

e Tax deposited with Form 7004 . . . . . . . . . . . . . . . 32e

f Credits: (1) Form 2439 (2) Form 4136 32f

g Refundable credits from Form 3800, line 19c, and Form 8827, line 8c . . . 32g 32h

33 Estimated tax penalty (see instructions). Check if Form 2220 is attached . . . . . . . . 33

34 Amount owed. If line 32h is smaller than the total of lines 31 and 33, enter amount owed . . . . 3435 Overpayment. If line 32h is larger than the total of lines 31 and 33, enter amount overpaid . . . . . 3536 Enter amount from line 35 you want: Credited to 2011 estimated tax Refunded 36

Sign Here



May the IRS discuss this return with the preparer shown below (see instructions)? Yes No



PTIN



For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11450Q Form 1120 (2010)

FDIC CODE PRIOR YEAR EIN

STORED GENERATED TOTAL RECEIPTS INCOME ADJUSTMENT

INCLUDED IN LINE 26: TOTAL AMORTIZATION

INTANGIBLE DRILLING COST: PRODUCTIVE W LS NON-PRODUCTIVE WELLS,

ESOP DIVIDENDS UNIDENTIFIED OR AMORTIZED

DEDUCTION ADJUSTMENT

ADJUSTMENT TAX PAYMENT

MERGE EIN

373Corporation Programs

Form 1120 (2010) Page 2Schedule A Cost of Goods Sold (see instructions)

1 Inventory at beginning of year . . . . . . . . . . . . . . . . . . . . 1

2 Purchases . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Cost of labor . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Additional section 263A costs (attach schedule) . . . . . . . . . . . . . . . . 4

5 Other costs (attach schedule) . . . . . . . . . . . . . . . . . . . . . 5

6 Total. Add lines 1 through 5 . . . . . . . . . . . . . . . . . . . . . . 6

7 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . 7

8 Cost of goods sold. Subtract line 7 from line 6. Enter here and on page 1, line 2 . . . . . . 8

9a Check all methods used for valuing closing inventory:

(i) Cost

(ii) Lower of cost or market

(iii) Other (Specify method used and attach explanation.)

b Check if there was a writedown of subnormal goods . . . . . . . . . . . . . . . . . . . . . .

c Check if the LIFO inventory method was adopted this tax year for any goods (if checked, attach Form 970) . . . . . .

d If the LIFO inventory method was used for this tax year, enter percentage (or amounts) of closing inventory computed under LIFO . . . . . . . . . . . . . . . . . . . . 9d

e If property is produced or acquired for resale, do the rules of section 263A apply to the corporation? . . . . Yes No

f Was there any change in determining quantities, cost, or valuations between opening and closing inventory? If “Yes,” attach explanation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Schedule C Dividends and Special Deductions (see instructions) (a) Dividends received

(b) % (c) Special deductions (a) × (b)

1 Dividends from less-than-20%-owned domestic corporations (other than debt-financed stock) . . . . . . . . . . . . . . . . . . . . . . . . 70

2 Dividends from 20%-or-more-owned domestic corporations (other than debt-financed stock) . . . . . . . . . . . . . . . . . . . . . . . . 80

3 Dividends on debt-financed stock of domestic and foreign corporations . . . . .see

instructions

4 Dividends on certain preferred stock of less-than-20%-owned public utilities . . . 425 Dividends on certain preferred stock of 20%-or-more-owned public utilities . . . . 486 Dividends from less-than-20%-owned foreign corporations and certain FSCs . . . 707 Dividends from 20%-or-more-owned foreign corporations and certain FSCs . . . 808 Dividends from wholly owned foreign subsidiaries . . . . . . . . . . . 1009 Total. Add lines 1 through 8. See instructions for limitation . . . . . . . .

10 Dividends from domestic corporations received by a small business investment company operating under the Small Business Investment Act of 1958 . . . . . 100

11 Dividends from affiliated group members . . . . . . . . . . . . . . 10012 Dividends from certain FSCs . . . . . . . . . . . . . . . . . 10013 Dividends from foreign corporations not included on lines 3, 6, 7, 8, 11, or 12 . . .

14 Income from controlled foreign corporations under subpart F (attach Form(s) 5471) .

15 Foreign dividend gross-up . . . . . . . . . . . . . . . . . .

16 IC-DISC and former DISC dividends not included on lines 1, 2, or 3 . . . . . .

17 Other dividends . . . . . . . . . . . . . . . . . . . . .

18 Deduction for dividends paid on certain preferred stock of public utilities . . . .

19 Total dividends. Add lines 1 through 17. Enter here and on page 1, li 4 . . .

20 Total special deductions. Add lines 9, 10, 11, 12, and 18. Enter here d on page 1, line 29b . . . . . . . Schedule E Compensation of Officers (see instructions for page 1, line 12)

Note: Complete Schedule E only if total receipts (line 1a plus lines 4 through 10 on page 1) are $500,000 or more.

(a) Name of officer (b) Social security number(c) Percent of

time devoted to business

Percent of corporation stock owned

(d) Common (e) Preferred(f) Amount of compensation

1 % % %

% % %

% % %

% % %

% % %

2 Total compensation of officers . . . . . . . . . . . . . . . . . . . . . . .

3 Compensation of officers claimed on Schedule A and elsewhere on return . . . . . . . . . .4 Subtract line 3 from line 2. Enter the result here and on page 1, line 12 . . . . . . . . . . .

Form 1120 (2010)

SEPARATE ALLOCATION FIELDS FOR: COMPENSATION OF OFFICERS AD DEBTS AXES INTEREST PAID ENTS ESOP DIV. INTANGIBLE DRILLING COSTS: PRODUCTIVE WELLS NON-PRODUCTIVE WEL UNIDENTIFIED OR ORTIZED ET DEPRECIATION CONTRIBUTIONS DEPLETION PENSIONS, ETC. EMPLOYEE BENEFITS OTAL AMORTIZATION DVERTISING

ADJUSTMENT TO BEGINNING INVENTORIES

ADJUSTMENT TO PURCHASES

DIVIDEND ADJUSTMENT

SPECIAL DEDUCTION ADJUSTMENT

DIVIDEND AFFILIATED

ADJ.


Form 1120 (2010) Page 3Schedule J Tax Computation (see instructions)

1 Check if the corporation is a member of a controlled group (attach Schedule O (Form 1120)) . . . .

2 Income tax. Check if a qualified personal service corporation (see instructions) . . . . . . . 2

3 Alternative minimum tax (attach Form 4626) . . . . . . . . . . . . . . . . . . . . 3

4 Add lines 2 and 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 a Foreign tax credit (attach Form 1118) . . . . . . . . . . . . . 5a

b Credit from Form 8834, line 29 . . . . . . . . . . . . . . . . 5b

c General business credit (attach Form 3800) . . . . . . . . . . . . 5c

d Credit for prior year minimum tax (attach Form 8827) . . . . . . . . . 5d

e Bond credits from Form 8912 . . . . . . . . . . . . . . . . 5e

6 Total credits. Add lines 5a through 5e . . . . . . . . . . . . . . . . . . . . . 6


8 Personal holding company tax (attach Schedule PH (Form 1120)) . . . . . . . . . . . . . . 8

9 Other taxes. Check if from: Form 4255 Form 8611 Form 8697

Form 8866 Form 8902 Other (attach schedule) . . . 9

10 Total tax. Add lines 7 through 9. Enter here and on page 1, line 31 . . . . . . . . . . . 10 Schedule K Other Information (see instructions)

1 Check accounting method: a Cash b Accrual c Other (specify) Yes No

2 See the instructions and enter the:

a Business activity code no.

b Business activity

c Product or service

3 Is the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? . . . . . . . . . .If “Yes,” enter name and EIN of the parent corporation

4 At the end of the tax year:

a Did any foreign or domestic corporation, partnership (including any entity treated as a partnership), trust, or tax-exempt organization own directly 20% or more, or own, directly or indirectly, 50% or more of the total voting power of a classes of the corporation’s stock entitled to vote? If "Yes," complete Part I of Schedule G (Form 1120) (attach Schedule G) . . . . .

b Did any individual or estate own directly 20% or more, or own, directly or indirectly, 50% or more of the total voting power of all classes of the corporation’s stock entitled to vote? If "Yes," complete Part II of Schedule G (Form 1120) (attach Schedule G)

5 At the end of the tax year, did the corporation:

a Own directly 20% or more, or own, directly or indirectly, 50% or more of the total voting power of all classes of stock entitled to vote of any foreign or domestic corporation not included on Form 851, Affiliations Schedule? For rules of constructive ownership, see instructionsIf “Yes,” complete (i) through (iv).

(i) Name of Corporation(ii) Employer

Identification Number (if any)

(iii) Country of Incorporation

(iv) Percentage Owned in Voting

Stock

Form 1120 (2010)

INCOME TAX ADJUSTMENT

ADJUSTMENT TO TOTAL

SOI INDUSTRY CODE

EIN NAME

Recapture Taxes from: QUALIFIED ELECTRIC VEHICLE CREDIT INDIAN EMPLOYMENT CREDIT

FOREIGN TAX CREDIT ADJ


Form 1120 (2010) Page 4Schedule K Continued

b Own directly an interest of 20% or more, or own, directly or indirectly, an interest of 50% or more in any foreign or domestic partnership (including an entity treated as a partnership) or in the beneficial interest of a trust? For rules of constructive ownership, see instructions

If “Yes,” complete (i) through (iv).

NoYes

(i) Name of Entity(ii) Employer

Identification Number (if any)

(iii) Country of Organization(iv) Maximum

Percentage Owned in Profit, Loss, or Capital

6 During this tax year, did the corporation pay dividends (other than stock dividends and distributions in exchange for ock) in excess of the corporation’s current and accumulated earnings and profits? (See sections 301 and 316.) . . . . . .

If "Yes," file Form 5452, Corporate Report of Nondividend Distributions.

If this is a consolidated return, answer here for the parent corporation and on Form 851 for each subsidiary.

7 At any time during the tax year, did one foreign person own, directly or indirectly, at least 25% of (a) the total voting power of all classes of the corporation’s stock entitled to vote or (b) the total value of all classes of the corporation’s stock? . . . .

For rules of attribution, see section 318. If “Yes,” enter:(i) Percentage owned and (ii) Owner’s country

(c) The corporation may have to file Form 5472, Information Return of a 25% Foreign-Owned U.S. Corporation or a Foreign Corporation Engaged in a U.S. Trade or Business. Enter the number of Forms 5472 attached

8 Check this box if the corporation issued publicly offered debt instruments with original issue discount . . . . . .

If checked, the corporation may have to file Form 8281, Information Return for Publicly Offered Original Issue Di ount Instruments.

9 Enter the amount of tax-exempt interest received or accrued during the tax year $

10 Enter the number of shareholders at the end of the tax year (if 100 or fewer)

11 If the corporation has an NOL for the tax year and is electing to forego the carryback period, check here . . . .

If the corporation is filing a consolidated return, the statement required by Regulations section 1.1502-21(b)(3) must be attached or the election will not be valid.

12 Enter the available NOL carryover from prior tax years (do not reduce it by any deduction on line 29a.) $

13 Are the corporation’s total receipts (line 1a plus lines 4 through 10 on page 1) for the tax year and its total ets at the end of the tax year less than $250,000? . . . . . . . . . . . . . . . . . . . . . . . . . . .

If “Yes,” the corporation is not required to complete Schedules L, M-1, and M-2 on page 5. Instead, enter the total amount of cash distributions and the book value of property distributions (other than cash) made during the tax year. $

14 Is the corporation required to file Schedule UTP (Form 1120), Uncertain Tax Position Statement (see instructions)? . . . .

If “Yes,” complete and attach Schedule UTP.Form 1120 (2010)


Form 1120 (2010) Page 5Schedule L Balance Sheets per Books Beginning of tax year End of tax year

( ) ( )

( ) ( )

( ) ( )

( ) ( )

( ) ( )

Assets (a) (b) (c) (d)

1 Cash . . . . . . . . . . . .

2a Trade notes and accounts receivable . . .

b Less allowance for bad debts . . . . .

3 Inventories . . . . . . . . . . .

4 U.S. government obligations . . . . .

5 Tax-exempt securities (see instructions) . .

6 Other current assets (attach schedule) . . .

7 Loans to shareholders . . . . . . .

8 Mortgage and real estate loans . . . . .

9 Other investments (attach schedule) . . .

10a Buildings and other depreciable assets . .

b Less accumulated depreciation . . . . .

11a Depletable assets . . . . . . . . .

b Less accumulated depletion . . . . . .

12 Land (net of any amortization) . . . . .

13a Intangible assets (amortizable only) . . .

b Less accumulated amortization . . . .

14 Other assets (attach schedule) . . . .15 Total assets . . . . . . . . . .

Liabilities and Shareholders’ Equity16 Accounts payable . . . . . . . . .

17 Mortgages, notes, bonds payable in less than 1 year

18 Other current liabilities (attach schedule) . .

19 Loans from shareholders . . . . . . .

20 Mortgages, notes, bonds payable in 1 year or more

21 Other liabilities (attach schedule) . . . .

22 Capital stock: a Preferred stock . . . .

b Common stock . . . .

23 Additional paid-in capital . . . . . . .

24 Retained earnings—Appropriated (attach schedule)

25 Retained earnings—Unappropriated . . .

26 Adjustments to shareholders’ equity (attach schedule)

27 Less cost of treasury stock . . . . .28 Total liabilities and shareholders’ equity . .

Schedule M-1 Reconciliation of Income (Loss) per Books With Income per Return Note: Schedule M-3 required instead of Schedule M-1 if total assets are $10 million or more—see instructions

1 Net income (loss) per books . . . . . .

2 Federal income tax per books . . . . .

3 Excess of capital losses over capital gains .

4 Income subject to tax not recorded on books this year (itemize):

5 Expenses recorded on books this year not deducted on this return (itemize):

a Depreciation . . . . $

b Charitable contributions . $

c Travel and entertainment . $

6 Add lines 1 through 5 . . . . . . . .

7 Income recorded on books this year not included on this return (itemize):

Tax-exempt interest $

8 Deductions on this return not charged against book income this year (itemize):

a Depreciation . . $

b Charitable contributions $

9 Add lines 7 and 8 . . . . . . 10 Income (page 1, line 28)—line 6 less line 9

Schedule M-2 Analysis of Unappropriated Retained Earnings per Books (Line 25, Schedule L)1 Balance at beginning of year . . . . .


3 Other increases (itemize):

4 Add lines 1, 2, and 3 . . . . . . . .

5 Distributions: a Cash . . . .

b Stock . . . .

c Property . . .


7 Add lines 5 and 6 . . . . . .8 Balance at end of year (line 4 less line 7)

Form 1120 (2010)

FOR SOI INDUSTRY CODE 523110-523900

BALANCE SHEET CODE

ENDING FINANCIAL INVENTORIESBEGINNING FINANCIAL INVENTORIES

ASSET ADJUSTMENT END OF YEAR

LIABILITY ADJUSTMENT END OF YEAR

STOCK OPTIONS RESTRICTED STOCK

PARENT CASH DISTRIBUTION


SCHEDULE D (Form 1120)Department of the Treasury Internal Revenue Service

Capital Gains and Losses Attach to Form 1120, 1120-C, 1120-F, 1120-FSC, 1120-H, 1120-IC-DISC, 1120-L, 1120-ND, 1120-PC,

1120-POL, 1120-REIT, 1120-RIC, 1120-SF, or certain Forms 990-T.


OMB No. 1545-0123

2010Name Employer identification number


(a) Description of property (Example: 100 shares of Z Co.)



(d) Sales price (see instructions)

(e) Cost or other basis (see

instructions)

(f) Gain or (loss) (Subtract (e) from (d))

1

2 Short-term capital gain from installment sales from Form 6252, line 26 or 37 . . . . . . . . . . 2

3 Short-term gain or (loss) from like-kind exchanges from Form 8824 . . . . . . . . . . . 3

4 Unused capital loss carryover (attach computation) . . . . . . . . . . . . . . . . 4 ( )

5 Net short-term capital gain or (loss). Combine lines 1 through 4 . . . . . . . . . . . . 5Part II Long-Term Capital Gains and Losses—Assets Held More Than One Year

6

7 Enter gain from Form 4797, line 7 or 9 . . . . . . . . . . . . . . . . . . . . . 7

8 Long-term capital gain from installment sales from Form 6252, line 26 or 37 . . . . . . . . . . 8

9 Long-term gain or (loss) from like-kind exchanges from Form 8824 . . . . . . . . . . . 9

10 Capital gain distributions (see instructions) . . . . . . . . . . . . . . . . . . . 10

11 Net long-term capital gain or (loss). Combine lines 6 through 10 . . . . . . . . . . . . 11Part III Summary of Parts I and II

12 Enter excess of net short-term capital gain (line 5) over net long-term capital loss (line 11) . . . . 12

13 Net capital gain. Enter excess of net long-term capital gain (line 11) over net short-term capital loss (line 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

14 Add lines 12 and 13. Enter here and on Form 1120, page 1, line 8, or the proper line on other returns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Note. If losses exceed gains, see Capital losses in the instructions.

For Paperwork Reduction Act Notice, see the Instructions for Form 1120. Cat. No. 11460M Schedule D (Form 1120) (2010)


SCHEDULE G (Form 1120)


Information on Certain Persons Owning the Corporation’s Voting Stock

Attach to Form 1120. See instructions on page 2.

OMB No. 1545-0123

2010Name Employer identification number (EIN)

Part I Certain Entities Owning the Corporation’s Voting Stock. (Form 1120, Schedule K, Question 4a). Complete columns (i) through (v) below for any foreign or domestic corporation, partnership (including any entity treated as a partnership), trust, or tax-exempt organization that owns directly 20% or more, or owns, directly or indirectly, 50% or more of the total voting power of all classes of the corporation’s stock entitled to vote (see instructions).

(i) Name of Entity(ii) Employer Identification

Number (if any)(iii) Type of Entity (iv) Country of Organization (v) Percentage Owned in Voting Stock

Part II Certain Individuals and Estates Owning the Corporation’s Voting Stock. (Form 1120, Schedule K, Question 4b). Complete columns (i) through (iv) below for any individual or estate that owns directly 20% or more, or owns, directly or indirectly, 50% or more of the total voting power of all classes of the corporation’s stock entitled to vote (see instructions).

(i) Name of Individual or Estate(ii) Identifying Number

(if any)

(iii) Country of Citizenship (see

instructions)

(iv) Percentage Owned in Voting Stock

For Paperwork Reduction Act Notice, see the Instructions for Form 1120.

Cat. No. 52684S Schedule G (Form 1120) 2010


SCHEDULE M-3 (Form 1120)


Net Income (Loss) Reconciliation for Corporations With Total Assets of $10 Million or More

Attach to Form 1120 or 1120-C. See separate instructions.

OMB No. 1545-0123

2010Name of corporation (common parent, if consolidated return) Employer identification number

Check applicable box(es): (1) Non-consolidated return (2) Consolidated return (Form 1120 only)

(3) Mixed 1120/L/PC group (4) Dormant subsidiaries schedule attached

Part I Financial Information and Net Income (Loss) Reconciliation (see instructions)

1a Did the corporation file SEC Form 10-K for its income statement period ending with or within this tax year?Yes. Skip lines 1b and 1c and complete lines 2a through 11 with respect to that SEC Form 10-K.No. Go to line 1b. See instructions if multiple non-tax-basis income statements are prepared.

b Did the corporation prepare a certified audited non-tax-basis income statement for that period?Yes. Skip line 1c and complete lines 2a through 11 with respect to that income statement.No. Go to line 1c.

c Did the corporation prepare a non-tax-basis income statement for that period?Yes. Complete lines 2a through 11 with respect to that income statement.No. Skip lines 2a through 3c and enter the corporation’s net income (loss) per its books and records on line 4a.

2a Enter the income statement period: Beginning MM/ /YYYY Ending MM D/YYYYb Has the corporation’s income statement been restated for the income statement period on line 2a?

Yes. (If “Yes,” attach an explanation and the amount of each item restated.)No.

c Has the corporation’s income statement been restated for any of the five income statement periods preceding the period on line 2a?Yes. (If “Yes,” attach an explanation and the amount of each item restated.)No.

3a Is any of the corporation’s voting common stock publicly traded?Yes.

No. If “No,” go to line 4a.b Enter the symbol of the corporation’s primary U.S. publicly traded voting common

stock . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Enter the nine-digit CUSIP number of the corporation’s primary publicly traded voting common stock . . . . . . . . . . . . . . . . . . . . . . .

4a Worldwide consolidated net income (loss) from income statement source identified in Part I, line 1 . . 4a b Indicate accounting standard used for line 4a (see instructions):

(1) GAAP (2) IFRS (3) Statutory (4) Tax-basis (5) Other (specify)5a Net income from nonincludible foreign entities (attach schedule) . . . . . . . . . . . . . 5a ( )

b Net loss from nonincludible foreign entities (attach schedule and enter as a positive amount) . . . . 5b6a Net income from nonincludible U.S. entities (attach schedule) . . . . . . . . . . . . . . 6a ( )

b Net loss from nonincludible U.S. entities (attach schedule and enter as a positive amount) . . . . . 6b7a Net income (loss) of other includible foreign disregarded entities (attach schedule) . . . . . . . 7a b Net income (loss) of other includible U.S. disregarded entities (attach schedule) . . . . . . . . 7bc Net income (loss) of other includible entities (attach schedule) . . . . . . . . . . . . . . 7c

8 Adjustment to eliminations of transactions between includible entities and nonincludible entities (attachschedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

9 Adjustment to reconcile income statement period to tax year (attach schedule) . . . . . . . . 9 10a Intercompany dividend adjustments to reconcile to line 11 (attach schedule) . . . . . . . . . 10a

b Other statutory accounting adjustments to reconcile to line 11 (attach schedule) . . . . . . . . 10bc Other adjustments to reconcile to amount on line 11 (attach schedule) . . . . . . . . . . . 10c

11 Net income (loss) per income statement of includible corporations. Combine lines 4 through 10 . . . 11 Note. Part I, line 11, must equal the amount on Part II, line 30, column (a), and Schedule M-2, line 2.

12 Enter the total amount (not just the corporation’s share) of the assets and liabilities of all entities included or removed on the following lines.

Total Assets Total Liabilitiesa Included on Part I, line 4 . . . . . . b Removed on Part I, line 5 . . . . . . c Removed on Part I, line 6 . . . . . . d Included on Part I, line 7 . . . . . .

For Paperwork Reduction Act Notice, see the Instructions for Form 1120. Cat. No. 37961C Schedule M-3 (Form 1120) 2010


Schedule M-3 (Form 1120) 2010 Page 2 Name of corporation (common parent, if consolidated return) Employer identification number

Check applicable box(es): (1) Consolidated group (2) Parent corp (3) Consolidated eliminations (4) Subsidiary corp (5) Mixed 1120/L/PC group

Check if a sub-consolidated: (6) 1120 group (7) 1120 eliminations

Name of subsidiary (if consolidated return) Employer identification number

Part II Reconciliation of Net Income (Loss) per Incom Statement of Includible Corporations With Taxable Income per Return (see instructions)

( ) ( )

Income (Loss) Items (Attach schedules for lines 1 through 11)

(a) Income (Loss) per Income Statement

(b) Temporary Difference

(c) Permanent Difference

(d) Income (Loss) per Tax Return

1 Income (loss) from equity method foreign corporations2 Gross foreign dividends not previously taxed . . 3 Subpart F, QEF, and similar income inclusions .4 Section 78 gross-up . . . . . . . . . .5 Gross foreign distributions previously taxed . .6 Income (loss) from equity method U.S. corporations .

7 U.S. dividends not eliminated in tax consolidation 8 Minority interest for includible corporations . .9 Income (loss) from U.S. partnerships . . . . . .

10 Income (loss) from foreign partnerships . . . . .

11 Income (loss) from other pass-through entities .12 Items relating to reportable transactions (attach

details) . . . . . . . . . . . . . .

13 Interest income (attach Form 8916-A) . . . .14 Total accrual to cash adjustment . . . . . .15 Hedging transactions . . . . . . . . .16 Mark-to-market income (loss) . . . . . . .17 Cost of goods sold (attach Form 8916-A) . . .18 Sale versus lease (for sellers and/or lessors) . .

19 Section 481(a) adjustments . . . . . . . 20 Unearned/deferred revenue . . . . . . .21 Income recognition from long-term contracts .22 Original issue discount and other imputed interest 23a

Income statement gain/loss on sale, exchange, abandonment, worthlessness, or other disposition of assets other than inventory and pass-through entities

b Gross capital gains from Schedule D, excluding amounts from pass-through entities . . . . .

c

Gross capital losses from Schedule D, excluding amounts from pass-through entities, abandonment losses, and worthless stock losses . . . . .

d

Net gain/loss reported on Form 4797, line 17, excluding amounts from pass-through entities, abandonment losses, and worthless stock losses

e Abandonment losses . . . . . . . . .f Worthless stock losses (attach details) . . . .g Other gain/loss on disposition of assets other than inventory

24 Capital loss limitation and carryforward used . .25 Other income (loss) items with differences (attach schedule)

26 Total income (loss) items. Combine lines 1 through 25

27 Total expense/deduction items (from Part III, line 38)

28 Other items with no differences . . . . . .29a Mixed groups, see instructions. All others, combine

lines 26 through 28 . . . . . . . . . .

b PC insurance subgroup reconciliation totals . .c Life insurance subgroup reconciliation totals . .

30 Reconciliation totals. Combine lines 29a through 29c Note. Line 30, column (a), must equal the amount on Part I, line 11, and column (d) must equal Form 1120, page 1, line 28.

Schedule M-3 (Form 1120) 2010M-3 BOOK ADJUSTMENT M-3 TEMPORARY ADJUSTMENT M-3 PERMANENT ADJUSTMENT M-3 RETURN ADJUSTMENT


Schedule M-3 (Form 1120) 2010 Page 3 Name of corporation (common parent, if consolidated return) Employer identification number


Check if a sub-consolidated: (6) 1120 group (7) 1120 eliminations


Part III Reconciliation of Net Income (Loss) per Income Statement of Includible Cor orations With Taxable Income per Return—Expense/Deduction Items (see instructions)

Expense/Deduction Items

(a) Expense per

Income Statement



(d) Deduction per

Tax Return

1 U.S. current income tax expense . . . . . .2 U.S. deferred income tax expense . . . . .3 State and local current income tax expense . .4 State and local deferred income tax expense . .5 Foreign current income tax expense (other than

foreign withholding taxes) . . . . . . . .

6 Foreign deferred income tax expense . . . .7 Foreign withholding taxes . . . . . . . .8 Interest expense (attach Form 8916-A) . . . .9 Stock option expense . . . . . . . . .

10 Other equity-based compensation . . . . . 11 Meals and entertainment . . . . . . . . 12 Fines and penalties . . . . . . . . . . 13 Judgments, damages, awards, and similar costs 14 Parachute payments . . . . . . . . . . 15 Compensation with section 162(m) limitation . .16 Pension and profit-sharing . . . . . . . . 17 Other post-retirement benefits . . . . . . 18 Deferred compensation . . . . . . . . . 19 Charitable contribution of cash and tangible

property . . . . . . . . . . . . . .

20 Charitable contribution of intangible property . 21 Charitable contribution limitation/carryforward . 22 Domestic production activities deduction . . .23 Current year acquisition or reorganization

investment banking fees . . . . . . . .24 Current year acquisition or reorganization legal and

accounting fees . . . . . . . . . . .

25 Current year acquisition/reorganization other costs 26 Amortization/impairment of goodwill . . . .27 Amortization of acquisition, reorganization, and

start-up costs . . . . . . . . . . . .

28 Other amortization or impairment write-offs . . 29 Section 198 environmental remediation costs . 30 Depletion . . . . . . . . . . . . . 31 Depreciation . . . . . . . . . . . . 32 Bad debt expense . . . . . . . . . . 33 Corporate owned life insurance premiums . .34 Purchase versus lease (for purchasers and/or

lessees) . . . . . . . . . . . . . . 35 Research and development costs (attach schedule) 36 Section 118 exclusion (attach schedule) . . . 37 Other expense/deduction items with differences

(attach schedule) . . . . . . . . . . .

38

Total expense/deduction items. Combine lines 1 through 37. Enter here and on Part II, line 27, reporting positive amounts as negative and negative amounts as positive . . . . . . .

Schedule M-3 (Form 1120) 2010


SCHEDULE N (Form 1120)


Foreign Operations of U.S. Corporations Attach to Form 1120, 1120-C, 1120-IC-DISC, 1120-L, 1120-PC,

1120-REIT, 1120-RIC, or 1120S.

OMB No. 1545-0123

2010Name Employer identification number (EIN)

Foreign Operations Information

Yes No1 During the tax year, did the corporation own (directly or indirectly) any foreign entity that was disregarded as an

entity separate from its owner under Regulations sections 301.7701-2 and 301.7701-3 (see instructions)? . . .

b Enter the number of Forms 8858 attached to the tax return . . . . . . . . . . .

2 Enter the number of Forms 8865, Return of U.S. Persons With Respect to Certain Foreign Partnerships, attached to the corporation’s income tax return . . . . . . . . . .

3 Excluding any partnership for which a Form 8865 is attached to the tax return, did the corporation own at least a 10% interest, directly or indirectly, in any other foreign partnership (including an entity treated as a foreign partnership under Regulations section 301.7701-2 or 301.7701-3)? . . . . . . . . . . . . . . . .If “Yes,” see instructions for required attachment.

4If “Yes,” attach Form 5471, Information Return of U.S. Persons With Respect to Certain Foreign Corporations, for each CFC.

b Enter the number of Forms 5471 attached to the tax return . . . . . . . . . . .

5 During the tax year, did the corporation receive a distribution from, or was it the grantor of, ransferor to, a foreign trust? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If “Yes,” the corporation may have to file Form 3520, Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts.

6 At any time during the 2010 calendar year, did the corporation have an interest in or a signature or other authority over a financial account (such as a bank account, securities account, or other financial account) in a fo ign country? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.

b If “Yes,” enter the name of the foreign country . . . . . . .

7 Is the corporation claiming the extraterritorial income exclusion? . . . . . . . . . . . . . . . . .If “Yes,” attach a separate Form 8873, Extraterritorial Income Exclusion, for each transaction or group of transactions.

b Enter the number of Forms 8873 attached to the tax return . . . . . . . . . . . c Enter the total of the amounts from line 52 (extraterritorial income exclusion (net of

disallowed deductions)) of all Forms 8873 attached to the tax return . . . . . . . $

If “Yes,” you are generally required to attach Form 8858, Information Return of U.S. Persons With Respect to Foreign Disregarded Entities, for each foreign disregarded entity (see instructions).

For Paperwork Reduction Act Notice, see the Instructions for Form 1120. Cat. No. 26294K Schedule N (Form 1120) 2010

a

a

a

a

Was the corporation a U.S. shareholder of any controlled foreign corporation (CFC)? (See sections 951 and 957.) . .


SCHEDULE O (Form 1120) Department of the Treasury Internal Revenue Service

Consent Plan and Apportionment Schedule for a Controlled Group

Attach to Form 1120, 1120-C, 1120-F, 1120-FSC, 1120-L, 1120-PC, 1120-REIT, or 1120-RIC. See separate instructions.

OMB No. 1545-0123


Part I Apportionment Plan Information1 Type of controlled group:

a Parent-subsidiary groupb Brother-sister groupc Combined groupd Life insurance companies only

2 This corporation has been a member of this group:a For the entire year.b From , 20 , until , 20 .

3 This corporation consents and represents to:a Adopt an apportionment plan. All the other members of this group are adopting an apportionment plan effective for

the current tax year which ends on , 20 , and for all succeeding tax years.b Amend the current apportionment plan. All the other members of this group are currently amending a previously

adopted plan, which was in effect for the tax year ending , 20 , and for all succeeding taxyears.

c Terminate the current apportionment plan and not adopt a new plan. All the other members of this group are not adopting an apportionment plan.

d Terminate the current apportionment plan and adopt a new plan. All the other members of this group are adoptingan apportionment plan effective for the current tax year which ends on , 20 , and for allsucceeding tax years.

4 If you checked box 3c or 3d above, check the applicable box below to indicate if the termination of the current apportionment plan was:

a Elected by the component members of the group.b Required for the component members of the group.

5 If you did not check a box on line 3 above, check the applicable box below concerning the status of the group’s apportionment plan (see instructions).

a No apportionment plan is in effect and none is being adopted.b An apportionment plan is already in effect. It was adopted for the tax year ending , 20 , and

for all succeeding tax years.

6 If all the members of this group are adopting a plan or amending the current plan for a tax year after the due date (including extensions) of the tax return for this corporation, is there at least one year remaining on the statute of limitations from the date this corporation filed its amended return for such tax year for assessing any resulting deficiency? See instructions.

a Yes.(i) The statute of limitations for this year will expire on , 20 .(ii) On , 20 , this corporation entered into an agreement with the

Internal Revenue Service to extend the statute of limitations for purposes of assessment until, 20 .

b No. The members may not adopt or amend an apportionment plan.

7 Required information and elections for component members. Check the applicable box(es) (see instructions).a The corporation will determine its tax liability by applying the maximum tax rate imposed by section 11 to the entire amount

of its taxable income.b The corporation and the other members of the group elect the FIFO method (rather than defaulting to the proportionate

method) for allocating the additional taxes for the group imposed by section 11(b)(1) .The corporation has a short tax year that does not include December 31.

For Privacy Act and Paperwork Reduction Act Notice, see Instructions for Form 1120.

Cat. No. 48100N Schedule O (Form 1120) (2010)

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SCHEDULE UTP (Form 1120)


Uncertain Tax Position Statement File with Form 1120, 1120-F, 1120-L, or 1120-PC.


OMB No. 1545-0000

2010Name of entity as shown on page 1 of tax return EIN of entity

This Part I, Schedule UTP (Form 1120) is page of Part I pages.

Part I Uncertain Tax Positions For the Current Tax Year. See instructions for how to complete columns (a) through (f). Enter, in Part III, a description for each uncertain tax position (UTP).

Check this box if the corporation was unable to obtain information from related parties sufficient to determine whether a tax position is a UTP (see instructions)

(a) UTP No.

(b) Primary IRC sections (e.g., "61", "108", etc.)

(c) Timing Codes

(check if Permanent, Temporary, or both)

(d) Pass-Through

Entity EIN

(e) Check if

Administrative Practice

(f) Maximum Tax

Adjustment (size of issue)

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 54658Q Schedule UTP (Form 1120) 2010


Schedule UTP (Form 1120) 2010 Page 2 Name of entity as shown on page 1 of tax return EIN of entity

This Part II, Schedule UTP (Form 1120) is page of Part II pages.

Part II Uncertain Tax Positions For Prior Tax Years. See instructions for how to complete columns (a) through (g). Enter, in Part III, a description for each uncertain tax position (UTP).

Check this box if the corporation was unable to obtain information from related parties sufficient to determine whether a tax position is a UTP (see instructions)

(a) UTP No.

(b) Primary IRC sections (e.g., "61", "108", etc.)

(c) Timing Codes

(check if Permanent, Temporary, or both)

(d) Pass-Through

Entity EIN

(e) Check if

Administrative Practice

(f) Maximum Tax

Adjustment (size of issue)

(g) Year of

Tax Position

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

P T -

Schedule UTP (Form 1120) 2010


Schedule UTP (Form 1120) 2010 Page 3 Name of entity as shown on page 1 of tax return EIN of entity

This Part III, Schedule UTP (Form 1120) is page of Part III pages.

Part III Concise Descriptions of UTPs. Indicate the UTP number from Part I or Part II in the first column. Use as many Part III pages as necessary.

UTP No. Concise Description of Uncertain Tax Position

Schedule UTP (Form 1120) 2010


Form 1120-FDepartment of the Treasury Internal Revenue Service

U.S. Income Tax Return of a Foreign CorporationFor calendar year 2010, or tax year beginning , 2010, and ending , 20


OMB No. 1545-0126

2010Use IRS label. Other- wise, print or type.

Name

Number, street, and room or suite no. (see instructions)

City or town, state and ZIP co , or country (see instructions)


Check box(es) if: Initial return

Name or address change Final return

First post-merger return Amended return

Schedule M-3 attached Protective return

A Country of incorporation

B Foreign country under whose laws the income reported on this return is also subject to tax

C Date incorporated

D (1) Location of corporation’s primary books and records (city, province or state, and country)

(2) Principal location of worldwide business

(3) If the corporation maintains an office or place of busine in the United States, check here . . . . . . . . .

E If the corporation had an agent in the United States at any time during the tax year, enter:

(1) Type of agent

(2) Name(3) Address

F See the instructions and enter the corpo ation’s principal:

(1) Business activity code number

(2) Business activity

(3) Product or service

G Check method of accounting: (1) Cash (2) Accrual

(3) Other (specify)

Yes NoH Did the corporation’s method of accounting change from the preceding tax year? . . . . . . . .

If “Yes,” attach an explanation.

I Did the corporation’s method of determining income change from the preceding tax year? . . . . .

If “Yes,” attach an explanation.

J Did the corporation file a U.S. income tax return for the preceding tax year? . . . . . . . . .

K (1) At any time during the tax year, was the corporation

engaged in a trade or business in United States?

(2) If “Yes,” is taxpayer’s trade or siness within the United States solely the result of a section 897 (FIRPTA) sale or disposition? . . . . . .

L At any time during the tax year, did the corporation have a permanent establishment in the United States for purposes of any applicable tax treaty between the United States and a foreign country? . . .

If “Yes,” enter the name of the foreign country:

M Did the corporation have any transactions with related parties?

If “Yes,” Form 5472 may have to be filed (see instructions).

Enter number of Forms 5472 attached Note: Additional information is required on page 2.

Computation of Tax Due or Overpayment1 Tax from Section I, line 11, page 2. . . . . . . . . . . . . . 1

2 Tax from Section II, Schedule J, line 9, page 4 . . . . . . . . . . 2

3 Tax from Section III (add lines 6 and 10 on page 5) . . . . . . . . . 3

4 Total tax. Add lines 1 through 3 . . . . . . . . . . . . . . . . . . . . . . . 4

5a 2009 overpayment credited to 2010 . . . 5a

b 2010 estimated tax payments . . . . . 5b

c Less 2010 refund applied for on Form 4466 5c ( )

d Combine lines 5a through 5c . . . . . . . . . . . . . . . 5d

e Tax deposited with Form 7004 . . . . . . . . . . . . . . . 5e

f Credit for tax paid on undistributed capital gains (attach Form 2439). . . . 5f

g Credit for federal tax on fuels (attach Form 4136). See instructions . . . . 5g

h Refundable credits from Form 3800, line 19c, and Form 8827, line 8c . . . 5h

i U.S. income tax paid or withheld at source (add line 12, page 2, and amounts from Forms 8288-A and 8805 (attach Forms 8288-A and 8805)) . . . . . 5i

j Total payments. Add lines 5d through 5i . . . . . . . . . . . . . . . . . . . . . 5j

6 Estimated tax penalty (see instructions). Check if Form 2220 is attached . . . . . . . 6

7 Amount owed. If line 5j is smaller than the total of lines 4 and 6, enter amount owed . . . . . . 7

8 a Overpayment. If line 5j is larger than the total of lines 4 and 6, enter amount overpaid . . . . . . . 8a

b Amount of overpayment on line 8a resulting from tax deducted and withheld under Chapter 3 (attach schedule—see instructions) 8b 9 Enter portion of line 8a you want Credited to 2011 estimated tax Refunded 9

Sign Here



May the IRS discuss this return with the preparer shown below (see instructions)?

Yes No



PTIN



For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11470I Form 1120-F (2010)

SOI INDUSTRY CODE

PRIOR YEAR EIN

FORM 8288P. 2, L. 12

TAX PAYMENT ADJUSTMENT


Form 1120-F (2010) Page 2 Additional Information (continued from page 1)

Yes NoN Is the corporation a controlled foreign corporation? (See section 957(a) for definition.) . . . . . .

O Is the corporation a personal service corporation? (See instructions for definition.) . . . . . . .

P Enter tax-exempt interest received or accru during the tax year (see instructions) $

Q At the end of the tax year, did the corporation own, directly or indirectly, 50% or more of the voting stock of a U.S. corporation? (See section 267(c) for rules of attribution.) . .If “Yes,” attach a schedule showing (1) name and EIN of such U.S. corporation; (2) percentage owned; and (3) taxable income or (loss) before NOL and special deductions of such U.S. corporation for the tax year ending with or within your tax year.

R If the corporation has an NOL for the tax year and is electing to forego the c yback period, check here . . . . . . . . . . . .

S Enter the available NOL carryover from prior tax years. (Do not reduce it by any deduction on line 30a, page 3.) $

T Is the corporation a subsidiary in a parent-subsidiary controlled group? . . . . . . . . . . .

If “Yes,” enter the parent corporation’s:

(1) EIN

(2) Name

U (1) Is the corporation a dealer under section 475? . .

(2) Did the corporation mark to market any securities or commodities other than in a dealer capacity?

Yes NoV At the end of the tax year, did any individual, partnership, corporation, estate, or trust own, directly or indirectly, 50% or more of the corporation’s voting stock? (See section 267(c) for rules of attribution.) If “Yes,” attach a schedule showing the name and identifying number. (Do not include any information already entered in item T.) Enter percentage owned

W Is the corporation taking a position on this return that a U.S. tax treaty overrules or modifies an Internal Revenue law of the United States, thereby causing a reduction of tax? .If “Yes,” the corporation is generally required to complete and attach Form 8833. See Form 8833 for exceptions.

Note: Failure to disclose a treaty-based return position may result in a $10,000 penalty (see section 6712).During the tax year, did the corporation own any entity that was disregarded as an entity separate from its owner under Regulations sections 301.7701-2 and 301.7701-3? . .If “Yes,” attach a statement listing the name, country under whose laws the entity was organized, and EIN (if any) of each such entity.

Y (1) Did a partnership allocate to the corporation a distributive share of income from a directly owned partnership interest, any of which is ECI or treated as ECI by the partnership or the partner? . . . . . . .If “Yes,” attach Schedule P. See instructions.

(2) During the tax year, did the corporation own at least a 10% interest, directly or indirectly, in any foreign partnership?

If “Yes,” see instructions for required attachment.

Z (1) Has the corporation made any allocation or reallocation of income based on section 482 and its regulations?

(2) Has the corporation recognized any interbranch amounts? If “Yes,” attach statement (see instructions).

AA Is the corporation required to file Schedule UTP (Form 1120), Uncertain Tax Position Statement (see tructions)? If "Yes," complete and attach Schedule UTP.

SECTION I— Income From U.S. Sources Not Effectively Connected With the Conduct of a Trade or Business in the United States—Do not report items properly withheld and reported on Form 1042-S. See instructions.Include below only income from U.S. sources that is not effectively connected with the conduct of a trade or business in the United States. Do not report items properly withheld and reported on Form 1042-S. Report only items that (a) are not correctly withheld at source or (b) are not correctly reported on Form 1042-S. The rate of tax on each item of gross income listed below is 30% (4% for the gross transportation tax) or such lower rate specified by tax treaty. No deductions are allowed against these types of income. Enter treaty rates where applicable. If the corporation is claiming a lower treaty rate, also complete item W above. If multiple treaty rates apply to a type of income (e.g., subsidiary and portfolio dividends or dividends received by disregarded entities), attach a schedule showing the amounts, tax rates, and withholding for each.

Name of treaty country, if any

(a) Class of income (see instructions)

(b) Gross amount

(c) Rate of tax (%)

(d) Amount of tax liability

(e) Amount of U.S. income tax

paid or withheld at the source

1 Interest . . . . . . . . . . .

2 Dividends . . . . . . . . . .

3 Rents . . . . . . . . . . . .

4 Royalties . . . . . . . . . . .

5 Annuities . . . . . . . . . . .

6

Gains from disposal of timber, coal, or domestic iron ore with a retained economic interest (attach supporting schedule) . . .

7

Gains from sale or exchange of patents, copyrights, etc. . . . . . . . . .

8 Fiduciary distributions (attach supporting schedule)

9 Gross transportation income (attach Schedule V)

10

Other fixed or determinable annual or periodic gains, profits, and income . . . . . .

11 Total. Enter here and on line 1, page 1 . . . . . . . . . . . . . . 12 Total. Enter here and include on line 5i, page 1 . . . . . . . . . . . . . . . . . . . .

13 Is the corporation fiscally transparent under the laws of the foreign jurisdiction with respect to any item of income listed above? Yes No

If “Yes,” attach a schedule that provides the information requested above with respect to each such item of income.Form 1120-F (2010)

NAMEEIN


Form 1120-F (2010) Page 3 SECTION II—Income Effectively Connected With the Conduct of a Trade or Business in the United States (see instructions)Important: Fill in all applicable lines and schedules. If you need more space, see Assembling the Return in the instructions.

Inco

me

1 a Gross receipts or sales b Less returns and allowances c Bal 1c

2 Cost of goods sold (Schedule A, line 8) . . . . . . . . . . . . . . . . . . . 2

3 Gross profit (subtract line 2 from line 1c) . . . . . . . . . . . . . . . . . . 3

4 Dividends (Schedule C, line 14) . . . . . . . . . . . . . . . . . . . . . 4

5 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Gross royalties . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 Capital gain net income (attach Schedule D (Form 1120)) . . . . . . . . . . . . . 8

9 Net gain or (loss) from Form 4797, Part II, line 17 (attach Form 4797) . . . . . . . . . . 9

10 Other income (see instructions—attach schedule) . . . . . . . . . . . . . . . 10

11 Total income. Add lines 3 through 10 . . . . . . . . . . . . . . . . . . 11

Ded

ucti

ons

(See

inst

ruct

ions

for

limita

tions

on

ded

uctio

ns.) 12 Compensation of officers (Schedule E, line 4) . . . . . . . . . . . . . . . . . 12

13 Salaries and wages (less employment credits) . . . . . . . . . . . . . . . . . 13

14 Repairs and maintenance . . . . . . . . . . . . . . . . . . . . . . . 14

15 Bad debts (for bad debts over $500,000, attach a list of debtors and amounts) . . . . . . . 15

16 Rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

17 Taxes and licenses . . . . . . . . . . . . . . . . . . . . . . . . . 17

18 Interest expense from Schedule I, line 25 (see instructions) . . . . . . . . . . . . . 18

19 Charitable contributions . . . . . . . . . . . . . . . . . . . . . . . . 19

20 Depreciation from Form 4562 not claimed on Schedule A or elsewhere on return (attach Form 4562) . 20

21 Depletion . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

22 Advertising . . . . . . . . . . . . . . . . . . . . . . . . 22

23 Pension, profit-sharing, etc., p s . . . . . . . . . . . . . . . . . . . 23

24 Employee benefit programs . . . . . . . . . . . . . . . . . . . . . . 24

25 Domestic production activities deduction (attach Form 8903) . . . . . . . . . . . . . 25

26 Deductions allocated and apportioned to ECI from Schedule H, line 20 (see instructions) . . . . . 26

27 Other deductions (attach schedule) . . . . . . . . . . . . . . . . . . 27

28 Total deductions. Add lines 12 through 27 . . . . . . . . . . . . . . . . . 28

29 Taxable income before NOL deduction and special deductions (subtract line 28 from line 11) . . 29

30 Less: a Net operating loss deduction (see instructions) . . . . 30a

b Special deductions (Schedule C, line 15) . . . . . . 30b

c Add lines 30a and 30b . . . . . . . . . . . . . . . . . . . . . 30c31 Taxable income or (loss). Subtract line 30c from line 29 . . . . . . . . . . . . . . 31

Schedule A Cost of Goods Sold (see instructions)1 Inventory at beginning of year . . . . . . . . . . . . . . . . . . . . . . . 1

2 Purchases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Cost of labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Additional section 263A costs (attach schedule). . . . . . . . . . . . . . . . . . . 4

5 Other costs (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Add lines 1 through 5 . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 Cost of goods sold. Subtract line 7 from line 6. Enter here and on Section II, line 2, above . . . . . 8

9 a Che all methods used for valuing closing inventory:

(1) Cost as described in Regulations section 1.471-3

(2) Lower of cost or market as described in Regulations section 1.471-4

(3) Other (Specify method used and attach explanation.)

b Check if there was a writedown of subnormal goods as described in Regulations section 1.471-2(c) . . . . . . . . . . .

c Check if the LIFO inventory method was adopted this tax year for any goods (if checked, attach Form 970) . . . . . . . . .

d If the LIFO inventory method was used for this tax year, enter percentage (or amounts) of closing inventory computed under LIFO . . . . . . . . . . . . . . . . . . . . . . . . . . 9d

e If property is produced or acquired for resale, do the rules of section 263A apply to the corporation? . . . . . . . Yes No

f Was there any change in determining quantities, cost, or valuations between opening and closing inventory? . . . . Yes NoIf “Yes,” attach explanation.

Form 1120-F (2010)

INCOME ADJUSTMENT

ADJUSTMENT TO BEGINNING INVENTORYADJUSTMENT TO PURCHASES

INCLUDED IN LINE 27: OTAL AM RTIZATION,NTANGIBLE DRILLING COSTS PRODUCTIVE WELLS,

NON-PRODUCTIVE WELLS, UNIDENTIFIED OR AMORTIZED

INCLUDES 17 ITEMS ALLOCATED FROM OTHER COSTS. PLEASE REFER TO FORM 1120, PAGE 2 FOR A LISTING OF THE SPECIFIC ITEMS.

PERCENTAMOUNT

ESOPDIVIDENDS

DEDUCTIONADJUSTMENT


Form 1120-F (2010) Page 4 SECTION II—Income Effectively Connected With the Conduct of a Trade or Business in the United States (continued)Schedule C Dividends and Special Deductions (see instructions)

(a) Dividends received (b) % (c) Special deductions:

(a) × (b)1 Dividends from less-than-20%-owned domestic corporations (other than

debt-financed stock) . . . . . . . . . . . . . . . . .

2 Dividends from 20%-or-more-owned domestic corporations (other than debt-financed stock) . . . . . . . . . . . . . . . . .

3 Dividends on debt-financed stock of domestic and foreign corporations (section 246A)

4 Dividends on certain preferred stock of less-than-20%-owned public utilities

5 Dividends on certain preferred stock of 20%-or-more-owned public utilities .

6 Dividends from less-than-20%-owned foreign corporations . . . . . .

7 Dividends from 20%-or-more-owned foreign corporations . . . . . .

8 Total. Add lines 1 through 7. See instructions for limitation . . . . . .

9 Dividends from foreign corporations not included on lines 3, 6, or 7 . . . .

10 Foreign dividend gross-up (section 78) . . . . . . . . . . . .

11 IC-DISC and former DISC dividends not included on lines 1, 2, or 3 (section 246(d))

12 Other dividends . . . . . . . . . . . . . . . . . .

13 Deduction for dividends paid on certain preferred stock of public utilities . .

14 Total dividends. Add lines 1 through 12. Enter here and on line 4, page 3 . .15 Total special deductions. Add lines 8 and 13. Enter here and on line 30b, page 3 . . . . . . . . .

Schedule E Compensation of Officers (See instructions for Section II, line 12.)Note: Complete Schedule E only if total receipts (line 1a plus lines 4 through 10 of Section II) are $500,000 or more.

(a) Name of officer(b) Social security

number

(c) Percent of time devoted to

business

Percent of corporation stock owned

(d) Common (e) Preferred

(f) Amount of compensation

1a % % %b % % %c % % %d % % %e % % %

2 Total compensation of officers . . . . . . . . . . . . . . . . . . . . . . .

3 Compensation of officers claimed on Schedule A and elsewhere on this return . . . . . . . . .4 Subtract line 3 from line 2. Enter the result here and on line 12, page 3 . . . . . . . . . . . .

Schedule J Tax Computation (see instructions)1 Check if the corporation is a member of a controlled group (attach Schedule O (Form 1120)) . . .

2 Income tax. Check if a qualified personal service corpo ion (see instructions) . . . . . . . 2

3 Alternative minimum tax (attach Form 4626) . . . . . . . . . . . . . . . . . . . 3

4 Add lines 2 and 3 . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5a Foreign tax credit (attach Form 1118) . . . . . . . . . . . . 5a

b General business credit (attach Form 3800) . . . . . . . . . . . 5b

c Credit for prior year minimum tax (attach Form 8827) . . . . . . . . 5c

d Bond credits from Form 8912 . . . . . . . . . . . . . . . 5d

6 Total credits. Add lines 5a through 5d . . . . . . . . . . . . . . . . . . . . . 6


8 Other taxes. Check if from: Form 4255 Form 8611 Form 8697

Form 8866 Form 8902 Other (attach schedule) . 8

9 Total tax. Add lines 7 and 8. Enter here and on line 2, page 1 . . . . . . . . . . . . . 9Form 1120-F (2010)

DIVIDEND ADJUSTMENT

RECAPTURE TAXES FROM LINE 8 "OTHER" : INDIAN EMPLOYMENT CREDIT

ADJUSTMENT TO TOTAL TAX


SPECIALDEDUCTIONADJUSTMENT

QUALIFIED ELECTRIC VEHICLE CR.

FOREIGN TAX CREDIT ADJ.


Form 1120-F (2010) Page 5 SECTION III—Branch Profits Tax and Tax on Excess InterestPart I—Branch Profits Tax (see instructions)

1 Enter the amount from Section II, line 29 . . . . . . . . . . . . . . . . . . . . . 1

2 Enter total adjustments to line 1 to get effectively connected earnings and profits. (Attach required schedule showing the nature and amount of adjustments.) (See instructions.) . . . . . . . . . . . . . 2

3 Effectively connected earnings and profits. Combine line 1 and line 2 . . . . . . . . . . . . 3

4 a Enter U.S. net equity at the end of the current tax year. (Attach required schedule.) . . . . . . . . 4a

b Enter U.S. net equity at the end of the prior tax year. (Attach required schedule.) . . . . . . . . . 4b

c Increase in U.S. net equity. If line 4a is greater than or equal to line 4b, subtract line 4b from line 4a. Enter the result here and skip to line 4e . . . . . . . . . . . . . . . . . . . . . . . . 4c

d Decrease in U.S. net equity. If line 4b is greater than line 4a, subtract line 4a from line 4b . . . . . . 4d

e Non-previously taxed accumulated effectively connected earnings and profits. Enter excess, if any, of effectively connected earnings and profits for preceding tax years beginning after 1986 over any dividend equivalent amounts for those tax years . . . . . . . . . . . . . . . . . . . . . 4e

5 Dividend equivalent amount. Subtract line 4c from line 3. If zero or less, enter -0-. If no amount is entered on line 4c, add the lesser of line 4d or line 4e to line 3 and enter the total here . . . . . . . . . . 5

6 Branch profits tax. Multiply line 5 by 30% (or lower treaty rate if the corporation is a qualified resident or otherwise qualifies for treaty benefits). Enter here and include on line 3, page 1. (See instructions.) Also complete item W on page 2 . . . . . . . . . . . . . . . . . . . . . . . . 6

Part II—Tax on Excess Interest (see instructions for this Part and for Schedule I (Form 1120-F))7 a Enter the interest from Section II, line 18 . . . . . . . . . . . . . . . . . . . . . 7a

b Enter the inverse of the total amount deferred, capitalized, and disallowed from Schedule I, line 24d (i.e., if line 24d is negative, enter as a positive number; if line 24d is positive, enter as a negative number) . . . . . 7b

c Combine lines 7a and 7b (amount must equal Schedule I, line 23) . . . . . . . . . . . . . 7c

8 Branch Interest (see instructions for definition): Enter the sum of Schedule I, line 9, column (c), and Schedule I, line 22. If the interest paid by the foreign corporation’s U.S. trade or business was increased because 80% or more of the

foreign corporation’s assets are U.S. assets, check this box . . . . . . . . . . . . . . . 8

9 a Excess interest. Subtract line 8 from line 7c. If zero or less, enter -0- . . . . . . . . . . . . 9a

b If the foreign corporation is a bank, enter the excess interest treated as interest on deposits (see instructions for rules for computing this amount). Otherwise, enter -0-. . . . . . . . . . . . . . . . 9b

c Subtract line 9b from line 9a . . . . . . . . . . . . . . . . . . . . . . . . 9c

10 Tax on excess interest. Multiply line 9c by 30% or lower treaty rate (if the corporation is a qualified resident or otherwise qualifies for treaty benefits). (See instructions.) Enter here and include on line 3, page 1. Also complete item W on page 2 . . . . . . . . . . . . . . . . . . . . . . . . 10

Part III—Additional InformationYes No

11 Is the corporation claiming a reduction in, or exemption from, the branch profits tax due to:

a A complete termination of all U.S. trades or businesses? . . . . . . . . . . . . . . . . . . . . . .

b The tax-free liquidation or reorganization of a foreign corporation? . . . . . . . . . . . . . . . . . . .

c The tax-free incorporation of a U.S. trade or business? . . . . . . . . . . . . . . . . . . . . . .

If 11a or 11b applies and the transferee is a domestic corporation, attach Form 8848. If 11c applies, attach the statement required by Temporary Regulations section 1.884-2T(d)(5).

Form 1120-F (2010)


Form 1120-F (2010) Page 6 Note: Check if completing on U.S. basis or Worldwide basis.Schedule L Balance Sheets per Books

Beginning of tax year End of tax year

( ) ( )

( ) ( )

( ) ( )

( ) ( )

( ) ( )


1 Cash . . . . . . . . . . . .

2a Trade notes and accounts receivable . . .

b Less allowance for bad debts . . . . .

3 Inventories . . . . . . . . . .

4 U.S. government obligations . . . . .

5 Tax-exempt securities (see instructions) . .

6a Interbranch current assets* . . . . .

b Other current non-U.S. assets* . . . .

c Other current U.S. assets* . . . . . .

7 Loans to shareholders . . . . . . .

8 Mortgage and real estate loans . . . .

9a

Other loans and investments—non-U.S. assets* . . . . . . . . . . .

b Other loans and investments—U.S. assets* .

10a Buildings and other depreciable assets . .

b Less accumulated depreciation . . . .

11a Depletable assets . . . . . . . .

b Less accumulated depletion . . . . .

12 Land (net of any amortization) . . . . .

13a Intangible assets (amortizable only) . . .

b Less accumulated amortization . . . .

14 Assets held in trust . . . . . . . .

15 Other non-current interbranch assets* . .

16a Other non-current non-U.S. assets* . . .

b Other non-current U.S. assets* . . . .17 Total assets . . . . . . . . . .

Liabilities18 Accounts payable . . . . . . . .

19

Mortgages, notes, bonds payable in less than 1 year:

a Interbranch liabilities* . . . . . . .

b Third-party liabilities* . . . . . . .

20 Other current liabilities* . . . . . . .

21 Loans from shareholders . . . . . .

22

Mortgages, notes, bonds payable in 1 year or more:

a Interbranch liabilities* . . . . . . .

b Third-party liabilities* . . . . . . .

23 Liabilities held in trust . . . . . . .

24a Other interbranch liabilities* . . . . .b Other third-party liabilities* . . . . . .

Equity (see instructions)25 Capital stock: a Preferred stock . . . .

b Common stock . . . .

26 Additional paid-in capital . . . . . .

27 Retained earnings—Appropriated* . . .

28 Retained earnings—Unappropriated . . .

29 Adjustments to shareholders’ equity* . . .

30 Less cost of treasury stock . . . . . .31 Total liabilities and shareholders’ equity . .

*Attach schedule—see instructions. Form 1120-F (2010)

BALANCE SHEET EDITED FOR LIFE INSURANCE AND PROPERTY AND CASUALTY ONLY.


SCHEDULES M-1 and M-2 (Form 1120-F)


Reconciliation of Income (Loss) and Analysis of Unappropriated Retained Earnings per Books

Attach to Form 1120-F.

OMB No. 1545-0126

2010Name of corporation Employer identification number

Schedule M-1 Reconciliation of Income (Loss) per Books With Income per Return Note: Schedule M-3 may be required instead of Schedule M-1—see instructions.

1 Net income (loss) per books . . . . .2 Federal income tax per books . . . .3 Excess of capital losses over capital gains4 Income subject to tax not recorded on

books this year (itemize):


a Depreciation . . . . $b Charitable contributions $c Travel and entertainment $d Other (itemize):

6 Add lines 1 through 5 . . . . . . .


a $Tax-exempt interest b Other (itemize):

8 Deductions on this return not charged against book income this year (itemize):

a Depreciation . . $b Charitable contributions $c Other (itemize):

9 Add lines 7 and 8 . . . . . . .10 Income—line 6 less line 9 . . . .

Schedule M-2 Analysis of Unappropriated Retained Earnings per Books

1 Balance at beginning of year . . . .2 Net income (loss) per books . . . . .3 Other increases (itemize):

4 Add lines 1, 2, and 3 . . . . . . .

5 Distributions: a Cash . . . .b Stock . . . .c Property . . .


7 Add lines 5 and 6 . . . . . . .8 Balance at end of year (line 4 less line 7) .

For Paperwork Reduction Act Notice, see the Instructions for Form 1120-F.

Cat. No. 49678K Schedules M-1 and M-2 (Form 1120-F) 2010


SCHEDULE M-3 (Form 1120-F)


Net Income (Loss) Reconciliation for Foreign Corporations With Reportable Assets of $10 Million or More

Attach to Form 1120-F. See separate instructions.

OMB No. 1545-0126


A Has the corporation reported taxable income on Form 1120-F, page 3, using a treaty provision to attribute business profits to a U.S. permanent establishment under rules other than section 864(c)? . . . . . . Yes No

B Did the corporation prepare a non-consolidated, worldwide, certified audited income statement for theperiod (see instructions)? . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

C Did the corporation prepare a non-consolidated, worldwide income statement for the period (see instructions)? Yes No

D Did the corporation prepare certified audited income statement(s) for the set(s) of books reported on Form 1120-F, Schedule L? . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No


1 Is the corporation a foreign bank as defined in Regulations section 1.882-5(c)(4)?Yes. Complete the remainder of Part I as follows:If D is “Yes,” use the income statement described in D to complete lines 2 through 5 and 7 through 11.If D is “No,” use the income statement(s) for the set(s) of books reported on Form 1120-F, Schedule L

to complete lines 2 through 5 and 7 through 11.

No. Complete the remainder of Part I as follows:If B is “Yes,” use the income statement described in B to complete lines 2 through 11.If B is “No” and C is “Yes,” use the income statement described in C to complete lines 2 through 11.If B and C are “No” and D is “Yes,” use the income statement described in D to complete lines 2 through 11.If B, C, and D are “No,” use the income statement described in the instructions to complete lines 2 through 11.

2a Enter the income statement period: Beginning Endingb Has the corporation’s income statement been restated for the income statement period entered on line 2a?

Yes. Attach an explanation and the amount of each item restated.No.

c Has the corporation’s income statement been restated for any of the 5 income statement periods preceding the period on line 2a?

Yes. Attach an explanation and the amount of each item restated.No.

3 Is any of the corporation’s stock publicly traded on any exchange, U.S. or foreign?Yes. List exchange(s) and symbol No.

4 Non-consolidated foreign corporation net income (loss) in U.S. dollars from the income statement source identified in line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5a Net income from includible disregarded foreign entities not included on line 4 (attach schedule) . . 5a b Net loss from includible disregarded foreign entities not included on line 4 (attach schedule) . . . 5b ( )

c Net income from includible disregarded U.S. entities not included on line 4 (attach schedule) . . . 5c d Net loss from includible disregarded U.S. entities not included on line 4 (attach schedule) . . . . 5d ( )

6 Net income (loss) from foreign locations not included on line 4 (attach schedule) . . . . . . . 6 7a Net income of non-includible entities (attach schedule) . . . . . . . . . . . . . . . . 7a ( )

b Net loss of non-includible entities (attach schedule) . . . . . . . . . . . . . . . . . 7b8 Adjustments to intercompany transactions (attach schedule) . . . . . . . . . . . . . . 8 9 Adjustments to reconcile income statement period to tax year (attach schedule) . . . . . . . 9

10 Other adjustments to reconcile to amount on line 11 (attach schedule) . . . . . . . . . . . 10 11 Adjusted financial net income (loss) of non-consolidated foreign corporation. Combine lines 4

through 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 For Paperwork Reduction Act Notice, see the Instructions for Form 1120-F.

Cat. No. 39667H

-


Schedule M-3 (Form 1120-F) 2010 Page 2 Name of corporation Employer identification number

Part II Reconciliation of Net Income (Loss) per Income Statement of Non-Consolidated Foreign Corporations With Taxable Income per Return (see instructions)

Income (Loss) Items(a)

Income (Loss) per Income Statement

(b) Temporary Differences

(c) Permanent Differences

(d) Other Permanent

Differences for Allocations to Non-ECI and ECI

(e) Income (Loss) per Tax Return

1 Gross receipts . . . . . . . .

2 Cost of goods sold (attach schedule) .

3a Dividends from foreign entities . . .

b Dividends from U.S. entities . . . .

c Substitute dividend payments received

4a Interest income excluding interest equivalents . . . . . . . . .

b Substitute interest payments received

c Interest equivalents not included on line 4b

5 Gross rental income . . . . . .

6 Gross royalty income . . . . . .

7 Fee and commission income . . .

8 Income (loss) from equity method corporations . . . . . . . .

9 Net income (loss) from U.S. partnerships

10 Net income (loss) from certain foreign partnerships (see instructions) . . .

11 Net income (loss) from other pass- through entities (attach schedule) . .

12 Items relating to reportable transactions (attach details) . . . . . . . .

13 Hedging transactions . . . . . .

14a Mark-to-market income (loss) under section 475(a) . . . . . . . .

b Mark-to-market income (loss) subject to section 475(d)(3)(B) . . . . . .

c Mark-to-market income (loss) under section 475(e) . . . . . . . .

d Mark-to-market income (loss) under section 475(f) . . . . . . . .

15 Gain (loss) from certain section 988 transactions . . . . . . . .

16a Interest income from global securities dealing . . . . . . . . . .

b Dividends from global securities dealing

c

Gains (losses) and other fixed and determinable, annual, or periodic income from global securities dealing not included on lines 16a and 16b . .

17 Sales versus lease (for sellers and/or lessors) . . . . . . . . . .

18 Section 481(a) adjustments . . . .

19 Unearned/deferred revenue . . . .20 Original issue discount, imputed

interest, and phantom income . . .21a

Income statement gain/loss on sale, exchange, abandonment, worthlessness, orother disposition of assets other thaninventory and pass-through entities . .

b

Gross capital gains from Schedule D,excluding amounts from pass-through entities . . . . . . . . . .



Part II Reconciliation of Net Income (Loss) per Income Statement of Non-Consolidated Foreign Corporations With Taxable Income per Return (see instructions) (continued from page 2)

Income (Loss) Items(a)




(d) Other Permanent


(e) Income (Loss) per Tax Return

21c

Gross capital losses from Schedule D, excluding amounts from pass-through entities, abandonment losses, and worthless stock losses . . . . .

d

Net gain/loss reported on Form 4797,line 17, excluding amounts from pass-through entities, abandonment losses, and worthless stock losses . .

e Abandonment losses . . . . . .

f Worthless stock losses (attach details) .

g Other gain/loss on disposition of assets other than inventory . . . . . .

22 Capital loss limitation and carryforward used . . . . . . . . . .

23

Gross effectively connected income of foreign banks from books that do not give rise to U.S. booked liabilities . . . . . . . . .

24 Other income (loss) items with differences (attach schedule) . . .

25 Total income (loss) items. Combine lines 1 through 24 . . . . . . .

26 Total expense/deduction items (from Part III, line 33) . . . . . . .

27 Other items with no differences . . .

28 Reconciliation totals. Combine lines 25 through 27 . . . . . .

Note. Line 28, column (a), must equal the amount on Part I, line 11, and column (e) must equal Form 1120-F, page 3, line 29.

Part III Reconciliation of Net Income (Loss) per Income Statement of Non-Consolidated Foreign Corporations With Taxable Income per Return (see instructions)

Expense/Deduction Items(a)

Expense per Income Statement



(d) Other Permanent


(e) Deduction per

Tax Return

1 U.S. current income tax expense . .

2 U.S. deferred income tax expense . .

3 Non-U.S. current income tax expense (other than foreign withholding taxes) .

4 Non-U.S. deferred income tax expense . . . . . . . . .

5 Non-U.S. withholding taxes . . . .

6 Compensation with section 162(m) limitation . . . . . . . . .

7 Salaries and other base compensation

8 Stock option expense . . . . .

9 Other equity-based compensation . .

10 Meals and entertainment . . . . .

11 Fines and penalties . . . . . .

12 Judgments, damages, awards, and similar costs . . . . . . . .



Part III Reconciliation of Net Income (Loss) per Income Statement of Non-Consolidated Foreign Corporations With Taxable Income per Return (see instructions) (continued from page 3)

( )





(d) Other Permanent


(e) Deduction per

Tax Return

13 Pension and profit-sharing . . . .

14 Other post-retirement benefits . . .

15 Deferred compensation . . . . .

16 Charitable contributions . . . . .

17 Domestic production activities deduction

18

Current year acquisition or reorganization investment banking fees, legal and accounting fees . . .

19 Current year acquisition/reorganization other costs . . . . . . . . .

20 Amortization/impairment of goodwill .

21 Amortization of acquisition, reorganization, and start-up costs . .

22 Other amortization or impairment write-offs . . . . . . . . .

23 Depreciation . . . . . . . .

24 Bad debt expense . . . . . .

25 Purchase versus lease (for purchasers and/or lessees) . . . . . . .

26a Interest expense per books . . . .

b

Interest expense under Regulations section 1.882-5 (from Schedule I (Form 1120-F), line 23) . . . . . . .

c

Regulations section 1.882-5 allocation amount subject to deferral or disallowance (from Schedule I (Form 1120-F), line 24d) . . . . . . .

d U.S. source substitute interest payments

e Interest equivalents (e.g., guarantee fees) not included on line 26d . . .

27 U.S. source substitute dividend payments . . . . . . . . .

28 Fee and commission expense . . .

29 Rental expense . . . . . . .

30 Royalty expense . . . . . . .

31

Expenses allocable to effectively connected income under Regulations section 1.861-8 from home office or other books that do not give rise to U.S. booked liabilities (from Schedule H (Form 1120-F), line 20) . . . . .

32 Other expense/deduction items with differences (attach schedule) . . .

33

Total expense/deduction items. Combine lines 1 through 32. Enter hereand on Part II, line 26 . . . . . .


Form 1120-LDepartment of the Treasury Internal Revenue Service

U.S. Life Insurance Company Income Tax ReturnFor calendar year 2010 or tax year beginning , 2010, ending , 20


OMB No. 1545-0128

2010

Please print or type

Name



A Check if:

1 Consolidated return (attach Form 851) .

2 Life-nonlife consoli-dated return . .

3 Schedule M-3 (Form 1120-L) attached . . .


C Date incorporated

D Check applicable box if an election has been m under section(s):

953(c)(3)(C) 953(d)E Check if: (1) Final return (2) Name change (3) Address change (4) Amended return

Inco

me

1 Gross premiums, etc., less return premiums, etc. Enter balance . . . . . . . . . . . . 1

2 Net decrease, if any, in reserves (see instructions) . . . . . . . . . . . . . . . . . 2

3 10% of any decrease in reserves under section 807(f)(1)(B)(ii) . . . . . . . . . . . . . . 3

4 Investment income (Schedule B, line 8) (see instructions) . . . . . . . . . . . . . . . 4

5 Net capital gain (Schedule D (Form 1120), line 13) . . . . . . . . . . . . . . . . . 5

6 Income from a special loss discount account (attach Form 8816) . . . . . . . . . . . 6

7 Other income (attach schedule) . . . . . . . . . . . . . . . . . . . . . . 7

8 Life insurance company gross income. Add lines 1 through 7 . . . . . . . . . . . . . . 8

Ded

ucti

ons

(See

inst

ruct

ions

for

limita

tions

on

ded

uctio

ns.) 9 Death benefits, etc. . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Net increase, if any, in reserves (Schedule F, line 35) . . . . . . . . . . . . . . . . 10

11 10% of any increase in reserves under section 807(f)(1)(B)(i) . . . . . . . . . . . . . . 11

12 Deductible policyholder dividends (Schedule F, line 18e) . . . . . . . . . . . . . . . 12

13 Assumption by another person of liabilities under insurance, etc., contracts . . . . . . . . . 13

14 Dividends reimbursable by taxpayer . . . . . . . . . . . . . . . . . . . . . 14

15a Interest b Less tax-exempt interest expense c Bal 15c

16 Deductible policy acquisition expenses (Schedule G, line 20) . . . . . . . . . . . . . 16

17 Additional deduction (attach Form 8816) . . . . . . . . . . . . . . . . 17

18 Other deductions (see instructions) (attach schedule) . . . . . . . . . . . . 18


20 Subtotal. Subtract line 19 from line 8 . . . . . . . . . . . . . . . . . . . . . 20

21a Dividends-received deduction (Schedule A, line 16, column (c)) . . . . 21a

Plus: b Operations loss deduction (see instructions) (attach schedule) . . 21b 21c

22 Gain or (loss) from operations. Subtract line 21c from line 20 . . . . . . . . . . . . . . 22

23 Small life insurance company deduction (Schedule H, line 17) . . . . . . . . . . . . . 23

24 Life insurance company taxable income (LICTI). Subtract line 23 from line 22 . . . . . . . . . 24

25 Limitation on noninsurance losses (Schedule I, line 9) . . . . . . . . . . . . . . . . 25

26 Amount subtracted from policyholders surplus account (Schedule J, Part II, line 10) . . . . . . . 26

Tax

and

Pay

men

ts

27 Taxable income. Add lines 24, 25, and 26 (see instructions) . . . . . . . . . . . . . . 27

28 Total tax (Schedule K, line 10) . . . . . . . . . . . . . . . . . . . . . . . 28

29a 2009 overpayment credited to 2010 . . . 29a

b Prior year(s) special estimated tax payments to be applied 29b

c 2010 estimated tax payments . . . . . 29c

d 2010 special estimated tax payments (Do not include on line 29f) . . . 29d

e Less 2010 refund applied for on Form 4466 . 29e ( ) 29f

g Tax deposited with Form 7004 . . . . . . . . . . . . . . 29g

h Credits: (1) Form 2439 (2) Form 4136 29h

i U.S. income tax paid or withheld at source (attach Form 1042-S) . . . . 29i

j Refundable credits from Form 3800, line 19c, and Form 8827, line 8c . . 29j 29k

30 Estimated tax penalty. Check if Form 2220 is attached . . . . . . . . . . . . . 30

31 Amount owed. If line 29k is smaller than the total of lines 28 and 30, enter amount owed . . . . . 31

32 Overpayment. If line 29k is larger than the total of lines 28 and 30, enter amount overpaid . . . . . 32

33 Enter amount from line 32: Credited to 2011 estimated tax Refunded 33

Sign Here






PTIN



For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11480E Form 1120-L (2010)

PRIOR YEAR EIN

COUNTRY OF INCORPORATION

TAX PAYMENT ADJ.

GROSS PREMIUMS

NET GAIN/LOSS

DEATH BENEFITS

TOTAL INCOME TOTAL DEDUCTIONS

COMPENSATION OF OFFICERSDOMESTIC PRODUCTION ACTIVITY DED., AX PAID ET DEPRECIATION EPARIS

ADVERTISING AD DEBT DEDUC ON ESOP DIVIDENDSENT PAID CONTRIBUTIONS OTAL AMORTIZATION

DEPLETION PENSION PROFIT SHARING EMPLOYEE BENEFIT PLAN DEDUCTION ADJUSTMENT

C

MERGE EIN


Form 1120-L (2010) Page 2 Schedule A Dividend Income and Dividends-Received Deduction (see instructions)

Dividends subject to proration(a) Dividends received (b) %

(c) Deduction ((a) times (b))

1 Domestic corporations, less-than-20%-owned (other than debt- financed stock) . . . . . . . . . . . . . . . 1 70

2 Domestic corporations, 20%-or-more-owned (other than debt- financed stock) . . . . . . . . . . . . . . . 2 80

3 Debt-financed stock of domestic and foreign corporations . . . 3 see instructions

4 Public utility corporations, less-than-20%-owned . . . . . 4 425 Public utility corporations, 20%-or-more-owned . . . . . . 5 486 Foreign corporations, less-than-20%-owned, and certain FSCs . 6 707 Foreign corporations, 20%-or-more-owned, and certain FSCs . 7 808 Wholly owned foreign subsidiaries (section 245(b)) and certain FSCs . 8 1009 Certain affiliated company dividends . . . . . . . . 9 100

10 Gross dividends-received deduction. Add lines 1 through 9 . . 10

11 Company share percentage (Schedule F ne 32) . . . . . 11

12 Prorated amount. Line 10 times line 11 . . . . . . . . 12Dividends not bject to proration

13 Affiliated company dividend . . . . . . . . . . . 13 see instructions

14 Other corporate divid s . . . . . . . . . . . 14

15 Total dividends. Add nes through 14, column (a). Enter here and on Schedule B, line 2 . . . . . . . . . . . 15

16 Total deductions. Add lines 12 and 13, column (c). Reduce the deduction as provided in section 805(a)(4)(D)(ii). Enter here and on page 1, line 21a and on Schedule J, Part I, line 2c . . . . . 16

Schedule B Gross Investment Income (section 812(d)) (see instructions)1 Interest (excluding tax-exempt interest) . . . . . . . . . . . . . . . . . . . . 1

2 Gross taxable dividends (Schedule A, line 15, column (a)) . . . . . . . . . . . . . . . 2

3 Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Gross royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Leases, terminations, etc. . . . . . . . . . . . . . . . . . . . . . . . 5

6 Excess of net short-term capital gain over net long-term capital loss (Schedule D (Form 1120), line 12) . . 6

7 Gross income from trade or business other than an insurance business (attach schedule) . . . . . . 7

8 Investment income. Add lines 1 through 7. Enter here and on page 1, line 4 . . . . . . . . . . 8

9 Tax-exempt interest. Enter here and on Schedule F, line 13 and Schedule J, Part I, line 2d . . . . . 9

10 Increase in policy cash value of section 264(f) policies as defined in section 805(a)(4)(F). Enter here and include on Schedule F, line 13 . . . . . . . . . . . . . . . . . . . . . . . 10

11 Add lines 8, 9, and 10 . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 100% qualifying dividends . . . . . . . . . . . . . . . . . . . . . . . . 12

13 Gross investment income. Subtract line 12 from line 11. Enter here and on Schedule F, line 9 . . . . 13

Form 1120-L (2010)

SPECIALDEDUCTIONADJUSTMENT

DIVS FROM CERTAIN FSCs

FSC 100% DEDUCTION

OTHER FOREIGN DIVIDENDSINCLUDABLE INCOME FROM CFCsFOREIGN DIVIDEND GROSS-UP

DIVIDENDS FROM IC-DISC OR FOREIGN DISC

DIVIDEND ADJUSTMENT

INCOME ADJUSTMENT

DIV-AFFIL-100-L L-AFFIL-GRPS-DED

DIV-AFFIL-100 AFFIL-GRPS-DED

DIV-RCVD-DED


Form 1120-L (2010) Page 3 Schedule F Increase (Decrease) in Reserves (section 807) and Company/Policyholder Share Percentage

(section 812) (see instructions)(a) Beginning of tax year (b) End of tax year

1 Life insurance reserves . . . . . . . . . . . . . . . . . . . 1

2 Unearned premiums and unpaid losses . . . . . . . . . . . . . . 2

3 Supplementary contracts . . . . . . . . . . . . . . . . . . 3

4 Dividend accumulations and other amounts . . . . . . . . . . . . . 4

5 Advance premiums . . . . . . . . . . . . . . . . . . . . 5

6 Special contingency reserves . . . . . . . . . . . . . . . . . 6

7 Add lines 1 through 6 . . . . . . . . . . . . . . . . . . . . 7

8 Increase (decrease) in reserves under section 807. Subtract line 7, column (a) from line 7, column (b) . . . 8

9 Gross investment income (Schedule B, line 13) . . . . . . . . . . . . . . . . . . . 9

10a Required interest on reserves under sections 807(c)(1), (3), (4), (5), and (6) (attach schedule) . . . . . . . . . . . . . . . . . . . . . 10a

b Deductible excess interest. Enter here and on lines 18b and 19 below . . . 10b

c Deductible amounts credited to employee pension funds . . . . . . . 10c

d Deductible amounts credited to deferred annuities . . . . . . . . . 10d

e Deductible interest on amounts left on deposit . . . . . . . . . . 10e

f Total policy interest. Add lines 10a through 10e. Enter here and on line 26 below . . . . . . . . . 10f

11 Subtract line 10f from line 9 . . . . . . . . . . . . . . . . . . . . . . . . 11

12 Life insurance company gross income (see instructions) . . . . . . . 12

13 Tax-exempt interest and the increase in policy cash value of section 264(f) policies as

defined in section 805(a)(4)(F). (Enter the sum of Schedule B, line 9 and line 10.) . . 13

14 Add lines 12 and 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

15 Increase in reserves from line 8. (If a decrease in reserves, enter -0-.) . . . . . . . . . . . . . 15


17 Investment income ratio. Divide line 11 by line 16 . . . . . . . . . . . . . . . . . . 17

18a Policyholder dividends paid or accrued . . . . . . . . . . . . 18a

b Excess interest from line 10b . . . . . . . . . . . . . . . 18b

c Premium adjustments . . . . . . . . . . . . . . . . . 18c

d Experience-rated refunds . . . . . . . . . . . . . . . . 18d

e Deductible policyholder dividends. Add lines 18a through 18d. Enter here and on page 1, line 12 . . . . 18e

19 Deductible excess interest from line 10b . . . . . . . . . . . . 19

20 Deductible dividends on employee pension funds . . . . . . . . . 20

21 Deductible dividends on deferred annuities . . . . . . . . . . . 21

22 Deductible premium and mortality charges for contracts paying excess interest 22

23 Add lines 19 through 22 . . . . . . . . . . . . . . . . . . . . . . . . . . 23

24 Subtract line 23 from line 18e . . . . . . . . . . . . . . . . . . . . . . . . 24

25 Investment portion of dividends. Line 17 times line 24 . . . . . . . . . . . . . . . . . 25

26 Policy interest from line 10f . . . . . . . . . . . . . . . . . . . . . . . . . 26

27 Policyholder share amount. Add lines 25 and 26 . . . . . . . . . . . . . . . . . . . 27

28 Net investment income (see instructions) . . . . . . . . . . . . . . . . . . . . . 28

29 Policyholder share amount from line 27 . . . . . . . . . . . . . . . . . . . . . 29

30 Company share of net investment income. Subtract line 29 from line 28 . . . . . . . . . . . . 30

31 Total share percentage . . . . . . . . . . . . . . . . . . . . . . . . . . 31 100%32 Company share percentage. Divide line 30 by line 28. Enter here and on Schedule A, line 11 . . . . . 32 %33 Policyholders’ share percentage. Subtract line 32 from line 31 . . . . . . . . . . . . . . 33 %

34 Policyholders’ share of tax-exempt interest and the increase in policy cash value of section 264(f) policies as defined in section 805(a)(4)(F). Multiply line 13 by line 33 . . . . . . . . . . . . . . . . 34

35 Net increase (decrease) in reserves. Subtract line 34 from line 8. If an increase, enter here and on page 1, line 10. If a (decrease), enter here and on page 1, line 2 . . . . . . . . . . . . . . . . . 35

Form 1120-L (2010)


Form 1120-L (2010) Page 4 Schedule G Policy Acquisition Expenses (section 848) (see instructions)

(a) Annuity(b) Group life

insurance(c) Other

1 Gross premiums and other consideration . . . . . . . . . . 1

2 Return premiums and premiums and other consideration incurred for reinsurance . . . . . . . . . . . . . . . . . . 2

3 Net premiums. Subtract line 2 from line 1 . . . . . . . . . . 3

4 Net premium percentage . . . . . . . . . . . . . . 4 1.75% 2.05% 7.7%5 Multiply line 3 by line 4 . . . . . . . . . . . . . . . 5

6 Combine line 5, columns (a), (b), and (c), and enter here. If zero or less, enter -0- on lines 7 and 8 . . . . . 6

7 Unused balance of negative capitalization amount from prior years . . . . . . . . . . . . . . 7 ( )

8 Combine lines 6 and 7. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . 8

9 General deductions (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . 9

10 Enter the lesser of line 8 or line 9 . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Deductible general deductions. Subtract line 10 from line 9. Enter here and include on page 1, line 18 . . . . 11

12 If the amount on line 6 is negative, enter it as a positive amount. If the amount on line 6 is positive, enter -0- . . 12

13 Unamortized specified policy acquisition expenses from prior years . . . . . . . . . . . . . . 13

14 Deductible negative capitalization amount. Enter the lesser of line 12 or line 13 . . . . . . . . . . . 14

15a Tentative 60-month specified policy acquisition expenses. Enter amount from line 10, but not more than $5 million . . . . . . . . . . . . . . . . . . . . . . 15a

b Limitation . . . . . . . . . . . . . . . . . . . . . . . . . 15b $10,000,00016 Phase-out amount. Subtract line 15b from line 10. If zero or less, enter -0- . . . . . . 16

17a Current year 60-month specified policy acquisition expenses. Subtract line 16 from line 15a. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . 17a

b Enter 10% of line 17a . . . . . . . . . . . . . . . . . . . . . . . . . . . 17b

18a Current year 120-month specified policy acquisition expenses. Subtract line 17a from line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . 18a

b Enter 5% of line 18a . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18b

19 Enter the applicable amount of amortization from specified policy acquisition expenses capitalized in prior years and deductible this year. Attach schedule . . . . . . . . . . . . . . . . . . . . . . 19

20 Deductible policy acquisition expenses. Add lines 14, 17b, 18b, and 19. Enter here and on page 1, line 16 . . 20

Form 1120-L (2010)


Form 1120-L (2010) Page 5 Schedule H Small Life Insurance Company Deduction (section 806(a)) (see instructions)

Part I—Controlled Group Information

Name of companyTentative LICTI

(a) Income (b) (Loss)

1

2

3

4

5

6 Add lines 1 through 5 in both columns . . . . . . . . . . . . . . . .

7 Net controlled group tentative LICTI. Subtract line 6, column (b) from line 6, column (a). Enter here and on line 11 below . . . . . . . . . . . . . . . . .

Part II—Small Life Insurance Company Deduction If total assets (Schedule L, Part I, line 6, column (b)), are $500 million or more, complete lines 8 through 12, line 16, and enter -0- on line 17 (see instructions).

8 Gain or (loss) from operations from page 1, line 22 . . . . . . . . . 8

9a Noninsurance income . . . . . . . . . . . . . . . . . 9a

b Noninsurance deductions . . . . . . . . . . . . . . . . 9b

10a Gain or (loss) on insurance operations. Subtract line 9a from line 8 and add line 9b . . . . . . . . . . . . . . . . . . . . . . 10a

b Adjustments (attach schedule) . . . . . . . . . . . . . . . 10b

c Tentative LICTI. Combine lines 10a and 10b . . . . . . . . . . . 10c

11 Net controlled group tentative LICTI from line 7 . . . . . . . . . . 11

12 Combined tentative LICTI. Add line 10c and line 11. If $15 million or more, skip lines 13 through 15 and enter -0- on line 17 below and on page 1, line 23 . . 12

13 Enter 60% of line 12, but not more than $1,800,000 . . . . . . . . . . . . . . . . . . 13

14a Maximum statutory amount . . . . . . . . . . . . . . . . 14a $3,000,000

b Subtract line 14a from line 12. If zero or less, enter -0- . . . . . . . . 14b

c Enter 15% of line 14b, but not more than $1,800,000 . . . . . . . . . . . . . . . . . 14c

15 Tentative small life insurance company deduction. Subtract line 14c from line 13 . . . . . . . . . 15

16 Taxpayer’s share. Divide line 10c by the total of line 6, column (a) and line 10c. If line 10c is zero or less, enter -0- on this line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

17 Small life insurance company deduction. Multiply line 15 by line 16. Enter here and on page 1, line 23, and on Schedule J, Part I, line 2b . . . . . . . . . . . . . . . . . . . . . . . . 17

Schedule I Limitation on Noninsurance Losses (section 806(b)(3)(C)) (see instructions)

1 Noninsurance income (attach schedule) . . . . . . . . . . . . . . . . . . . . . 1

2 Noninsurance deductions (attach schedule) . . . . . . . . . . . . . . . . . . . . 2

3 Noninsurance operations loss deductions . . . . . . . . . . . . . . . . . . . . . 3

4 Add lines 2 and 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Noninsurance loss. Subtract line 1 from line 4. If line 1 is greater than line 4, skip lines 5 through 8 and enter -0- on line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Enter 35% of line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Enter 35% of the excess of LICTI (page 1, line 24) over any noninsurance loss included on page 1 . . . . 7

8 Enter the lesser of line 6 or line 7 . . . . . . . . . . . . . . . . . . . . . . . 8

9 Limitation on noninsurance losses. Subtract line 8 from line 5. Enter here and on page 1, line 25 . . . . 9

Form 1120-L (2010)


Form 1120-L (2010) Page 6 Schedule J Part I—Shareholders Surplus Account (Stock Companies Only) (section 815(c)) (see instructions)

1 a Balance at the beginning of the tax year . . . . . . . . . . . . . . . . . . . . . 1a

b Transfers under pre-1984 sections 815(d)(1) and (4) for the preceding year . . . . . . . . . . . 1b

c Balance at the beginning of the tax year. Add lines 1a and 1b . . . . . . . . . . . . . . . 1c

2 a LICTI. Add lines 24 and 25, page 1. If zero or less, enter -0- . . . . . . . . . . . . . . . 2a

b Small life insurance company deduction (Schedule H, line 17) . . . . . . . . . . . . . . . 2b

c Dividends-received deduction (Schedule A, line 16, column (c)) . . . . . . . . . . . . . . 2c

d Tax-exempt interest (Schedule B, line 9) (see instructions) . . . . . . . . . . . . . . . . 2d

3 Add lines 1c through 2d . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Tax liability without regard to section 815. Figure the tax on line 2a as if it were total taxable income . . . 4

5 Subtract line 4 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . 5

6 Direct or indirect distributions in the tax year but not more than line 5 . . . . . . . . . . . . 6

7 Balance at the end of the tax year. Subtract line 6 from line 5 . . . . . . . . . . . . . . . 7 Part II—Policyholders Surplus Account (Stock Companies Only) (section 815(d)) (see instructions)

8 Balance at the beginning of the tax year . . . . . . . . . . . . . . . . . . . . . 8

9 a Direct or indirect distributions in excess of the amount on line 5, Part I above . 9a

b Tax increase on line 9a . . . . . . . . . . . . . . . . . 9b

c Subtractions from account under pre-1984 sections 815(d)(1) and (4) . . . . 9c

d Tax increase on line 9c . . . . . . . . . . . . . . . . . 9d

e Subtraction from account under pre-1984 sections 815(d)(2) . . . . . . 9e

10 Add lines 9a through 9e, but not more than line 8. Enter here and on page 1, line 26 . . . . . . . . 10

11 Balance at the end of the tax year. Subtract line 10 from line 8 . . . . . . . . . . . . . . 11 Schedule K Tax Computation (see instructions)

1 Check if the corporation is a member of a controlled group (attach Schedule O (Form 1120)) . . .

2 Income tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2


4 Add lines 2 and 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 a Foreign tax credit (attach Form 1118) . . . . . . . . . . . . . 5a

b Credit from Form 8834, line 29 . . . . . . . . . . . . . . . 5b

c General business credit (attach Form 3800) . . . . . . . . . . . 5c

d Credit for prior year minimum tax (attach Form 8827) . . . . . . . . 5d

e Bond credits from Form 8912 . . . . . . . . . . . . . . . 5e

6 Total credits. Add lines 5a through 5e . . . . . . . . . . . . . . . . . . . . . 6


8 Foreign corporations—tax on income not effectively connected with U.S. business . . . . . . . . 8

9 Other taxes. Check if from: Form 4255 Form 8611 Other tach schedule) . . . . . . 9 10 Total tax. Add lines 7 through 9. Enter here and on page 1, line 28 . . . . . . . . . . . . 10

Form 1120-L (2010)

RECAPTURE TAX FROM: QUALIFIED ELECTRIC VEHICLE CREDIT, INDIAN EMPLOYMENT CREDIT,


TAX FROM FORM 8697 TAX FROM FORM 8866

NUM-F8865

INCOME TAX CREDIT ADJUSTMENT L-ALT-TX


Form 1120-L (2010) Page 7 Schedule L Part I—Total Assets (section 806(a)(3)(C)) (see instructions)

(a) Beginning of tax year (b) End of tax year

1 Real property . . . . . . . . . . . . . . . . . . . . . . 1

2 Stocks . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Proportionate share of partnership and trust assets . . . . . . . . . . . 3

4 Other assets (attach schedule) . . . . . . . . . . . . . . . . . 4

5 Total assets of controlled groups . . . . . . . . . . . . . . . . 5

6 Total assets. Add lines 1 through 5 . . . . . . . . . . . . . . . 6Part II—Total Assets and Total Insurance Liabilities (section 842(b)(2)(B)(i)) (see instructions)Line references below are to the “Assets” (lines 1 and 2) and “Liabilities, Surplus, and Other Funds” (lines 3 through 13) sections of the NAIC Annual Statement.


1 Subtotals for assets (line 26) . . . . . . . . . . . . . . . . . 1

2 Total assets (line 28) . . . . . . . . . . . . . . . . . . . . 2

3 Reserve for life policies and contracts (line 1) . . . . . . . . . . . . . 3

4 Reserve for accident and health policies (line 2) . . . . . . . . . . . . 4

5 Liability for deposit-type contracts (line 3) . . . . . . . . . . . . . . 5

6 Life policy and contract claims (line 4.1) . . . . . . . . . . . . . . 6

7 Accident and health policy and contract claims (line 4.2) . . . . . . . . . 7

8 Policyholder’s dividend and coupon accumulations (line 5) . . . . . . . . . 8

9 Premiums and annuity considerations received in advance less discount (line 8) . . 9

10 Surrender values on canceled policies (line 9.1) . . . . . . . . . . . . 10

11 Part of other amounts payable on reinsurance assumed (line 9.3) . . . . . . . 11

12 Part of aggregate write-ins for liabilities (line 25). (Only include items or amounts includible in “total insurance liabilities on U.S. business” as defined in section 842(b)(2)(B)(i)) . . . . . . . . . . . . . . . . . . . . . . . . 12

13 Separate accounts statement (line 27) . . . . . . . . . . . . . . . 13

14 Total insurance liabilities. Add lines 3 through 13 . . . . . . . . . . . 14

Form 1120-L (2010)


Form 1120-L (2010) Page 8 Schedule M Other Information (see instructions)

1 Check method of accounting: Yes No

a Accrual b Other (specify)

2 Check if the corporation is a:

a Legal reserve company—if checked

Kind of company:

(1) Stock (2) Mutual

Principal business:

(1) Life Insurance

(2) Health and accident insurance

b Fraternal or assessment association

c Burial or other insurance company

3 Enter the percentage that the total of the corporation’s life insurance reserves (section 816(b)) plus unearned premiums and unpaid losses (whether or not ascertained) on noncancelable life, health or accident policies not included in life insurance reserves bears to the corporation’s total reserves (section 816(c)) %.

Attach a schedule of the computation.

4 Does the corporation have any variable annuity contracts outstanding? . . . . . . . .

5 At the end of the tax year, did the corporation own, directly or indirectly, 50% or more of the voting stock of a domestic corporation? (For rules of attribution, see section 267(c).) . . . . . .

If “Yes,” attach a schedule showing (a) name and employer identification number (EIN), (b) percentage owned, and (c) taxable income or (loss) before NOL and special deductions of such corporation for the tax year ending with or within your tax year.

6 Is the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? . . .

If “Yes,” enter name and EIN of the parent corporation.

7 At the end of the tax year, did anyindividual, partnership, corporation, estate, or trust own, directly or indirectly, 50% or more of the corporation’s voting stock? (For rules of attribution, see section 267(c).) If “Yes,” complete a and b below . . . . . . . . . .

a Attach a schedule showing name and identifying number. (Do not include any information already entered in 6 above.)

b Enter percentage owned

8 At any time during the year, did one foreign person own, directly or indirectly, at least 25% of (a) the total voting power of all classes of stock of the corporation entitled to vote or (b) the total value of all classes of stock of the corporation? . . .

Yes No

If “Yes,” enter: a Percentage owned

and b Owner’s country

c The corporation may have to file Form 5472, Information Return of a 25% Foreign-Owned U.S. Corporation or a Foreign Corporation Engaged in a U.S. Trade or Business. Enter number of Forms 5472 attached

9 Has the corporation elected to use its own payout pattern for discounting unpaid losses and unpaid loss adjustment expenses? . . . . . . . . .

10 Does the corporation discount any of the loss reserves shown on its annual statement? . . . .

11a Enter the total unpaid losses shown on the corporation’s annual statement:

(1) For the current year: $

(2) For the previous year: $

b Enter the total unpaid loss adjustment expenses shown on the corporation’s annual statement:

(1) For the current year: $

(2) For the previous year: $

12 If the corporation has an operations loss deduction (OLD) for the tax year and is electing under section 810(b)(3) to forego the carryback period, check here . . . . . . . . . . .


13 Enter the available OLD carryover from prior tax years. (Do not reduce it by any deductio on page 1, line 21b.) $

14a Enter the corporation’s state of domicile

b Was the annual statement used to prepare the tax return filed with the state of domicile? . . . . .

If “No,” complete c below.

c Enter the state where the annual statement used to prepare the tax return was filed

Form 1120-L (2010)

15 Is the corporation required to file Schedule UTP (Form 1120), Uncertain Tax Position Statement (see instructions)? . . . . . . . . . . .

If "Yes," complete and attach Schedule UTP.

NAMEEIN

SOI INDUSTRY CODE

STOCK, MUTUAL, FRATERNAL OR BURIAL

PBA-CD

★


SCHEDULE M-3 (Form 1120-L)


Net Income (Loss) Reconciliation for U.S. Life Insurance Companies With Total Assets of $10 Million or More

▶ Attach to Form 1120-L. ▶ See separate instructions.

OMB No. 1545-0128

2010Name of corporation (common parent, if consolidated return) Employer identification number

Check applicable box(es): (1) Non-consolidated return (2) Consolidated return (Form 1120-L only)(3) Mixed 1120/L/PC group (4) Dormant subsidiaries schedule attached

Part I Financial Information and Net Income (Loss) Reconciliation (see instructions)1 a Did the corporation file SEC Form 10-K for its income statement period ending with or within this tax year?

Yes. Skip lines 1b and 1c and complete lines 2a through 11 with respect to that SEC Form 10-K.No. Go to line 1b. See instructions if multiple non-tax-basis income statements are prepared.


c Did the corporation prepare a non-tax-basis income statement for that period?Yes. Complete lines 2a through 11 with respect to that income statement.No. Skip lines 2a through 3c and enter the corpora on’s net income (loss) per its books and records on line 4a.

2 a Enter the income statement period: Beginning Endingb Has the corporation’s income statement been restated for the income statement period on line 2a?



3 a Is any of the corporation’s voting common stock publicly traded?Yes.No. If “No,” go to line 4a.

b Enter the symbol of the corporation’s primary U.S. publicly traded voting common stock c Enter the nine-digit CUSIP number of the corporation’s primary publicly traded voting

common stock . . . . . . . . . . . . . . . . . . . . . . .

4 a Worldwide consolidated net income (loss) from income statement source identified in Part I, line 1 . 4a b Indicate accounting standard used for line 4a (see instructions):

(1) GAAP (2) IFRS (3) Statutory (4) Other (specify)5 a Net income from nonincludible foreign entities (attach schedule) . . . . . . . . . . . . . 5a ( )

b Net loss from nonincludible foreign entities (attach schedule and enter as a positive amount) . . . 5b6 a Net income from nonincludible U.S. entities (attach schedule) . . . . . . . . . . . . . 6a ( )

b Net loss from nonincludible U.S. entities (attach schedule and enter as a positive amount) . . . . 6b7 a Net income (loss) of other includible foreign disregarded entities (attach schedule) . . . . . . . 7a

b Net income (loss) of other includible U.S. disregarded entities (attach schedule) . . . . . . . 7bc Net income (loss) of other includible corporations (attach schedule) . . . . . . . . . . . . 7c

8 Adjustment to eliminations of transactions between includible entities and nonincludible entities (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8


b Other statutory accounting adjustments to reconcile to line 11 (attach schedule) . . . . . . . 10bc Other adjustments to reconcile to amount on line 11 (attach schedule) . . . . . . . . . . . 10c

11 Net income (loss) per income statement of includible corporations. Combine lines 4a through 10c Note. Part I, line 11, must equal the amount on Part II, line 30, column (a).

11


Total Assets Total Liabilitiesa Included on Part I, line 4 . . . .b Removed on Part I, line 5 . . . c Removed on Part I, line 6 . . . d Included on Part I, line 7 . . . .

For Paperwork Reduction Act Notice, see the Instructions for Form 1120-L. Cat. No. 39668S Schedule M-3 (Form 1120-L) 2010

M3-RTN-CD REV-YR-SCHM3


Schedule M-3 (Form 1120-L) 2010 Page 2 Name of corporation (common parent, if consolidated return) Employer identification number


Check if a sub-consolidated: (6) 1120-L group (7) 1120-L eliminations


Part II Reconciliation of Net Income (Loss) per Income Statement of Includible Corporations With Taxable Income per Return (see instructions)





(d) Income (Loss) per

Tax Return

1 Income (loss) from equity method foreign corporations 2 Gross foreign dividends not previously taxed . . . 3 Subpart F, QEF, and similar income inclusions . .4 Section 78 gross-up . . . . . . . . . . . 5 Gross foreign distributions previously taxed . . . 6 Income (loss) from equity method U.S. corporations . .7 U.S. dividends not eliminated in tax consolidation . 8 Minority interest for includible corporations . . . . 9 Income (loss) from U.S. partnerships . . . . . .

10 Income (loss) from foreign partnerships . . . . . 11 Income (loss) from other pass-through entities . .

12 Items relating to reportable transactions (attach details) 13 Interest income (attach Form 8916-A) . . . . . 14 Accrual of bond discount . . . . . . . . . 15 Hedging transactions . . . . . . . . . . . 16 Mark-to-market income (loss) . . . . . . . .17 Deferred and uncollected premiums . . . . . . 18 Sale versus lease (for sellers and/or lessors) . . .

19 Section 481(a) adjustments . . . . . . . . . 20 Amortization of interest maintenance reserve . . . 21 Original issue discount and other imputed interest .22 Market discount reclassification . . . . . . .23a

Income statement gain/loss on sale, exchange, abandonment, worthlessness, or other disposition of assets other than pass-through entities . . . . .

b Gross capital gains from Schedule D, excluding amounts from pass-through entities . . . . . .

c

Gross capital losses from Schedule D, excluding amounts from pass-through entities, abandonment losses, and worthless stock losses . . . . . .

d

Net gain/loss reported on Form 4797, line 17, excluding amounts from pass-through entities, abandonment losses, and worthless stock losses .

e Abandonment losses . . . . . . . . . . .f Worthless stock losses (attach details) . . . . .g Other gain/loss on disposition of assets . . . . .

24 Capital loss limitation and carryforward used . . .25 Other income (loss) items with differences (attach schedule)26 Total income (loss) items. Combine lines 1 through 25 27 Total expense/deduction items (from Part III, line 41) 28 Other items with no differences . . . . . . . 29a Mixed groups, see instructions. All others, combine

lines 26 through 28 . . . . . . . . . . .

b 1120 subgroup reconciliation totals . . . . . .c PC insurance subgroup reconciliation totals . . .

30 Reconciliation totals. Combine lines 29a through 29cNote. Line 30, column (a) must equal the amount on Part I, line 11, and column (d) must equal Form 1120-L, page 1, line 20.

Schedule M-3 (Form 1120-L) 2010


Schedule M-3 (Form 1120-L) 2010 Page 3 Name of corporation (common parent, if consolidated return) Employer identification number


Check if a sub-consolidated: (6) 1120-L group (7) 1120-L eliminations


Part III Reconciliation of Net Income (Loss) per Income Statement of Includible Corporations With Taxable Income per Return—Expense/Deduction Items (see instructions)





(d) Deduction per

Tax Return

1 U.S. current income tax expense . . . . . . . 2 U.S. deferred income tax expense . . . . . . 3 State and local current income tax expense . . . 4 State and local deferred income tax expense . . . 5

Foreign current income tax expense (other than foreign withholding taxes) . . . . . . . . .

6 Foreign deferred income tax expense . . . . .

7 Foreign withholding taxes . . . . . . . . . 8 Equity-based compensation . . . . . . . . 9 Capitalization of deferred acquisition costs . . . .

10 Amortization of deferred acquisition costs . . . . 11 Meals and entertainment . . . . . . . . . . 12 Fines and penalties . . . . . . . . . . . 13 Judgments, damages, awards, and similar costs . . 14 Parachute payments . . . . . . . . . . . 15 Compensation with section 162(m) limitation . . . 16 Pension and profit-sharing . . . . . . . . . 17 Other post-retirement benefits . . . . . . . . 18 Deferred compensation . . . . . . . . . . 19 Charitable contribution of cash and tangible property

20 Charitable contribution of intangible property . . . 21 Charitable contribution limitation/carryforward . . . 22 Change in section 807(c)(1) tax reserves . . . . . 23 Change in section 807(c)(2) tax reserves . . . . .

24 Change in all other section 807(c) tax reserves . .

25 Section 807(f) adjustments for change in computing reserves .

26

Section 807(a)(2)(B) tax reserve amount with respect to policyholder share of tax-exempt interest . . .

27 Current year acquisition/reorganization costs (attach schedule)

28 Amortization of acquisition, reorganization, and start-up costs 29

Amortization/impairment of goodwill, insurance in force and ceding commissions . . . . . . . .

30 Other amortization or impairment write-offs . . .

31 Section 846 amount . . . . . . . . . . . 32 Depreciation . . . . . . . . . . . . . . 33 Bad debt expense/agency balances written off . . 34 Corporate owned life insurance premiums . . . . 35 Purchase versus lease (for purchasers and/or lessees)36 Interest expense (attach Form 8916-A) . . . . .

37 Domestic production activities deduction . . . .

38 Research and development costs (attach schedule) .

39 Section 118 exclusion (attach schedule) . . . . .

40 Other expense/deduction items with differences (attach schedule) 41

Total expense/deduction items. Combine lines 1 through 40. Enter here and on Part II, line 27, reporting positive amounts as negative and negative amounts as positive .

Schedule M-3 (Form 1120-L) 2010

★


Form 1120-PCDepartment of the Treasury Internal Revenue Service

U.S. Property and Casualty Insurance Company Income ax Return

For calendar year 2010, or tax year beginning , 2010, and ending , 20 .


OMB No. 1545-1027

2010

Please print or type

Name



A Check if:

1 Consolidated return(attach Form 851) .

2 Life-nonlife consolidated return . .

3 Schedule M-3 (Form 1120-PC) attached . . .


C Date incorporated

D Check applicable box if an election has been de und section(s):

953(c)(3)(C) 953(d)E Check if: (1) Final return (2) Name change (3) Address change (4) Amended return

Tax

Co

mp

utat

ion

and

Pay

men

ts

1 Taxable income (Schedule A, line 37) . . . . . . . . . . . . . . . . . . . . . 1

2 Taxable investment income for electing small companies (Schedule B, line 21) . . . . . . . . . 2

3 Check if a member of a controlled group (attach Schedule O (Form 1120)) . . . . . . . .

4 Income tax . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Enter amount of tax that a reciprocal must include . . . . . . . . . . . . . . . . . 5


7 Add lines 4 through 6 . . . . . . . . . . . . . . . . . . . . . . . 7

8a Foreign tax credit (attach Form 1118) . . . . . . . . . . . 8a

b Credit from Form 8834, line 29 . . . . . . . . . . . . . . 8b

c General business credit (attach Form 3800) . . . . . . . . . . 8c

d Credit for prior year minimum tax (attach Form 8827) . . . . . . . 8d

e Bond credits from Form 8912 . . . . . . . . . . . . . . 8e

f Total credits. Add lines 8a through 8e . . . . . . . . . . . . . . . . . . . 8f

9 Subtract line 8f from line 7 . . . . . . . . . . . . . . . . . . . . . . 9

10 Foreign corporations—Tax on income not connected with U.S. busi s . . . . . . . . . . 10

11 Personal holding company tax (attach Schedule PH (Form 1120)) . . . . . . . . . . . 11

12 Other taxes. Check if from: Form 4255 Form 8611 Other (attach sched e) . . . 12

13 Total tax. Add lines 9 through 12 . . . . . . . . . . . . . . . . . . . 13

14a 2009 overpayment credited to 2010 . . . 14ab Prior year(s) special estimated tax payments

to be applied . . . . . . . . . . 14b

c 2010 estimated tax payments (see instructions) . 14c

d 2010 special estimated tax payments (Do not include on line 14f) . . . 14d

e 2010 refund applied for on Form 4466 . . . 14e ( )

f Enter the total of lines 14a through 14c less line 14e . . . . . . . 14f

g Tax deposited with Form 7004 . . . . . . . . . . . . . . 14g

h Credit by reciprocal for tax paid by attorney- -fact under section 835(d) . 14h

i Other credits and payments . . . . . . . . . . . . . 14i

j Refundable credits from Form 3800, line 19c, and Form 8827, line 8c . . 14j 14k

15 Estimated tax penalty (see instructions). Check if Form 2220 is attached . . . . . . . . 15

16 Amount owed. If line 14k is smaller than the total of lines 13 and 15, enter amount owed . . . . . 16

17 Overpayment. If line 14k is larger than the total of lines 13 and 15, enter amount overpaid . . . . . 1718 Enter amount from line 17: Credited to 2011 estimated tax Refunded 18

Sign Here






PTIN



For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 64270Q Form 1120-PC (2010)

PRIOR YEAR EIN

COUNTRY OF INCORPORATION

P-TAX BASE CODE


QUALIFIED ELECTRIC VEHICLE CREDIT

FOREIGN TAX CREDIT ADJUSTMENT

PERSONAL HOLDING CO. CODE

RECAPTURE TAXES FROM: INDIAN EMPLOYMENT CREDIT, QEV CREDIT

U.S. Income Tax Paid or Withheld at Source RIC CR. US SPECIAL FUELS TAX

TAX PAYMENT ADJ.

LBM-LTC-8697 LBM-PD-8866

SOI-INDY-CDPBA-CD

ADJ. TO TOTAL TAX

FOREIGN CODE


Form 1120-PC (2010) Page 2 Schedule A Taxable Income—Section 832 (see instructions)

Inco

me

1 Premiums earned (Schedule E, line 7) . . . . . . . . . . . . . . . . . . . . . 1


(a) Interest received(b) Amortization of

premium

3a Gross interest . . . . . . . . . . . . .

b Interest exempt under section 103 . . . . . . .

c Subtract line 3b from line 3a . . . . . . . .

d Taxable interest. Subtract line 3c, column (b) from line 3c, column (a) . . . . . . . . . . . 3d

4 Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Gross royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Capital gain net income (attach Schedule D (Form 1120)) . . . . . . . . . . . . . . . 6

7 Net gain or (loss) from Form 4797, Part II, line 17 (attach Form 4797) . . . . . . . . . . . 7

8 Certain mutual fire or flood insurance company premiums (section 832(b)(1)(D)) . . . . . . . . 8

9 Income on account of special income and deduction accounts . . . . . . . . . . . . . 9

10 Income from protection against loss account (see instructions) . . . . . . . . . . . . . 10

11 Mutual interinsurers or reciprocal underwriters—decrease in subscriber accounts . . . . . . . . 11

12 Income from a special loss discount account (attach Form 88 ) . . . . . . . . . . . . . 12

13 Other income (attach schedule) . . . . . . . . . . . . . . . . . . . . . 1314 Gross income. Add lines 1 through 13 . . . . . . . . . . . . . . . . . . . . 14

Ded

ucti

ons

(See

inst

ruct

ions

fo

r lim

itat

ions

on

ded

ucti

ons

.)

15 Compensation of officers (attach schedule) (see instructions) . . . . . . . . . . . . . . 15

16 Salaries and wages (less employment credits) . . . . . . . . . . . . . . . . . . 16

17 Agency balances and bills receivable that became worthless during the tax year . . . . . . . . 17

18 Rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

19 Taxes and licenses . . . . . . . . . . . . . . . . . . . . . . . . . . 19

20a Interest b Less tax-exempt interest exp. c Bal. 20c

21 Charitable contributions . . . . . . . . . . . . . . . . . . . . . . . . . 21

22 Depreciation (attach Form 4562) . . . . . . . . . . . . . . . . . . . . . . 22

23 Depletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

24 Pension, profit-sharing, etc., plans . . . . . . . . . . . . . . . . . . . . . 24

25 Employee benefit programs . . . . . . . . . . . . . . . . . . . . . . . 25

26 Losses incurred (Schedule F, line 14) . . . . . . . . . . . . . . . . . . . . . 26

27 Additional deduction (attach Form 8816) . . . . . . . . . . . . . . . . . . . . 27

28 Other capital losses (Schedule G, line 12, column (g)) . . . . . . . . . . . . . . . . 28

29 Dividends to policyholders . . . . . . . . . . . . . . . . . . . . . . . . 29

30 Mutual interinsurers or reciprocal underwriters—increase in subscriber accounts . . . . . . . 30

31 Other deductions (see instructions) (attach schedule) . . . . . . . . . . . . . 31

32 Total deductions. Add lines 15 through 31 . . . . . . . . . . . . . . . . . 32

33 Subtotal. Subtract line 32 from line 14 . . . . . . . . . . . . . . . . . . . . 33

34a Special deduction for section 833 organizations (Schedule H,line 9) . . . . . . . . . . . . . . . . . . . . . 34a

b Deduction on account of special income and deduction accounts . . . 34b

c Total. Add lines 34a and 34b . . . . . . . . . . . . . . . . . . . . . . . 34c

35 Subtotal. Subtract line 34c from line 33 . . . . . . . . . . . . . . . . . . . . 35

36a Dividends-received deduction (Schedule C, line 25) . . . . . . . 36a

b Net operating loss deduction . . . . . . . . . . . . . . 36b

c Total. Add lines 36a and 36b . . . . . . . . . . . . . . . . . . . . . . . 36c

37 Taxable income (subtract line 36c from line 35). Enter here and on page 1, line 1 . . . . . . . . 37Form 1120-PC (2010)

INCOME ADJUSTMENT

REPAIRS

TOTAL AMORTIZATION


ESOP DIVIDENDSADVERTISING


Form 1120-PC (2010) Page 3 Schedule B Part I—Taxable Investment Income of Electing Small Companies—Section 834 (see instructions)

Inco

me

(a) Interest received(b) Amortization of

premium

1a Gross interest . . . . . . . . . . . . .

b Interest exempt under section 103 . . . . . . .

c Subtract line 1b from line 1a . . . . . . . .

d Taxable interest. Subtract line 1c, column (b) from line 1c, column (a) . . . . . . . . . . . 1d


3 Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Gross royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Gross income from a trade or business, other than an insurance business, and from Form 4797 . . . 5

6 Income from leases described in sections 834(b)(1)(B) and 834(b)(1)(C) . . . . . . . . . . 6

7 Gain from Schedule D (Form 1120), line 14 . . . . . . . . . . . . . . . . . . . 78 Gross investment income. Add lines 1d through 7 . . . . . . . . . . . . . . . . . 8

Ded

ucti

ons

9 Real estate taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Other real estate expenses . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Depreciation (attach Form 4562) . . . . . . . . . . . . . . . . . . . . . . 11

12 Depletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

13 Trade or business deductions as provided in section 834(c)(8) (attach schedule) . . . . . . . . 13

14 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

15 Other capital losses (Schedule G, line 12, column (g)) . . . . . . . . . . . . . . . . 15

16 Total. Add lines 9 through 15 . . . . . . . . . . . . . . . . . . . . . . . 16

17 Investment expenses (attach schedule) . . . . . . . . . . . . . . . . . . . 17

18 Total deductions. Add lines 16 and 17 . . . . . . . . . . . . . . . . . . . 18


20 Dividends-received deduction (Schedule C, line 25) . . . . . . . . . . . . . . . . 20

21 Taxable investment income. Subtract line 20 from line 19. Enter here and on page 1, line 2 . . . . 21Part II—Invested Assets Book Values (Complete only if claiming a deduction for general expenses allocated to investment income.)


22 Real estate . . . . . . . . . . . . . . . . . . . . . 22

23 Mortgage loans . . . . . . . . . . . . . . . . . . . 23

24 Collateral loans . . . . . . . . . . . . . . . . . . . 24

25 Policy loans, including premium notes . . . . . . . . . . . . . 25

26 Bonds of domestic corporations . . . . . . . . . . . . . . 26

27 Stock of domestic corporations . . . . . . . . . . . . . . . 27

28 Government obligations, etc. . . . . . . . . . . . . . . . 28

29 Bank deposits bearing interest . . . . . . . . . . . . . . . 29

30 Other interest-bearing assets (attach schedule) . . . . . . . . . . 30

31 Total. Add lines 22 through 30 . . . . . . . . . . . . . . . 31

32 Add columns (a) and (b), line 31 . . . . . . . . . . . . . . . . . . . . . . . . 32

33 Mean of invested assets for the tax year. Enter one-half of line 32 . . . . . . . . . . . . . . 33

34 Multiply line 33 by .0025 . . . . . . . . . . . . . . . . . . . . . . . . . . 3435 Income base. Line 1b, column (a) plus line 8 less the sum of line 1b, column (b)

and line 16 . . . . . . . . . . . . . . . . . . . . . 35

36 Multiply line 33 by .0375 . . . . . . . . . . . . . . . . . 36

37 Subtract line 36 from line 35. Do not enter less than zero . . . . . . . 37

38 Multiply line 37 by .25 . . . . . . . . . . . . . . . . . . . . . . . . . . 38

39 Limitation on deduction for investment expenses. Add lines 34 and 38 . . . . . . . . . . . . 39Form 1120-PC (2010)

#

INCOME ADJUSTMENT

WHEN IDENTIFIABLE: COMPENSATION OF OFFICERS, SALARIES+WAGES, ESOP DIVS.,RENT PAID, TAXES PAID, A ERTISING, PENSION- OFIT SHARIN PLANS,EMPLOYEE BENEFIT PROGRAMS, TOTAL AMORTIZATION, AD DEBTS, EPAIRS


CONTRIBUTIONS

DP-PROD-ACTVTY-DED


Form 1120-PC (2010) Page 4 Schedule C Dividends and Special Deductions

(see instructions)Dividends-Received

(a) Subject to section 832(b)(5)(B)

(b) Total dividends- receivedIncome

1 Dividends from less-than-20%-owned domestic corporations (other than debt-financed stock) . . . . . . . . . . . . . . . . . . . . . 1

2 Dividends from 20%-or-more-owned domestic corporations (other than debt-financed stock) . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Dividends on debt-financed stock of domestic and foreign corporations . . . . . 3

4 Dividends on certain preferred stock of less-than-20%-owned public utilities . . . 4

5 Dividends on certain preferred stock of 20%-or-more-owned public utilities . . . . 5

6 Dividends on stock of certain less-than-20%-owned foreign corporations and certain FSCs . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Dividends on stock of certain 20%-or-more-owned foreign corporations and certain FSCs . . . . . . . . . . . . . . . . . . . . . . . . 7

8 Dividends from wholly owned foreign subsidiaries and certain FSCs . . . . . . 8

9 Dividends from affiliated companies . . . . . . . . . . . . . . 9

10 Other dividends from foreign corporations not included on lines 3, 6, 7, or 8 . . . . 10

11 Income from controlled foreign corporations under subpart F (attach Forms 5471) . . 11

12 Foreign dividend gross-up (section 78) . . . . . . . . . . . . . . 12

13 Other dividends (attach schedule) . . . . . . . . . . . . . . 13

14 Total dividends. Add lines 1 through 13. Enter here and on Schedule A, line 2, or Schedule B, line 2, whichever applies . . . . . . . . . . . . . . . 14

Deduction

Dividends-Received Deduction

(a) Subject to section 832(b)(5)(B)

(b) Total dividends- received deduction

15 Multiply line 1 by 70% . . . . . . . . . . . . . . . . . . . 15

16 Multiply line 2 by 80% . . . . . . . . . . . . . . . . . . . 16

17 Deduction for line 3 (see instructions) . . . . . . . . . . . . . . . 17

18 Multiply line 4 by 42% . . . . . . . . . . . . . . . . . . . 18

19 Multiply line 5 by 48% . . . . . . . . . . . . . . . . . . . 19

20 Multiply line 6 by 70% . . . . . . . . . . . . . . . . . . . 20

21 Multiply line 7 by 80% . . . . . . . . . . . . . . . . . . . 21

22 Enter the amount from line 8 . . . . . . . . . . . . . . . . . 22

23 Total. Add lines 15 through 22. (See instructions for limitation.) . . . . . . . 23

24 Total. Add line 23, column (a), and line 9, column (a Enter here and on Schedule F, line 10 . . . . . . . . . . . . . . . . . . . . . . . 24

25 Total deductions. Add line 23, column (b), and line 9, column (b). Enter here and on Schedule A, line 36a, or Schedule B, line 20, whichever applies . . . . . . . . . . . . . . . . . . . . . 25

Form 1120-PC (2010)

DIVIDENDS FROM IC-DISCDIVIDEND ADJUSTMENT

SPECIAL DEDUCTION ADJ.

DIVIDEND AFFILIATED ADJUSTMENT


Form 1120-PC (2010) Page 5 Schedule E Premiums Earned—Section 832 (see instructions)1 Net premiums written . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Unearned premiums on outstanding business at the end of the preceding tax year:a Enter 100% of life insurance reserves included in unearned premiums (section

832(b)(7)(A)) and all unearned premiums of qualifying section 833 organizations (see instructions) . . . . . . . . . . . . . . . . . . . 2a

b Enter 90% of unearned premiums attributable to insuring certain securities . . 2b

c Discounted unearned premiums attributable to title insurance . . . . . . 2c

d Enter 80% of all other unearned premiums (see instructions) . . . . . . 2d

e Total. Add lines 2a through 2d . . . . . . . . . . . . . . . . . . . . . . . . 2e

3 Total. Add lines 1 and 2e . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Unearned premiums on outstanding business at the end of the current tax year:a Enter 100% of life insurance reserves included in unearned premiums (section

832(b)(7)(A)) and all unearned premiums of qualifying section 833 organizations (see instructions) . . . . . . . . . . . . . . . . . . . 4a

b Enter 90% of unearned premiums attributable to insuring certain securities . . 4b

c Discounted unearned premiums attributable to title insurance . . . . . . 4c

d Enter 80% of all other unearned premiums (see instructions) . . . . . . 4d

e Total. Add lines 4a through 4d . . . . . . . . . . . . . . . . . . . . . . . . 4e

5 Subtract line 4e from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Transitional adjustments under section 832(b)(7)(D) (see instructions) . . . . . . . . . . . . . 67 Premiums earned. Add lines 5 and 6. Enter here and on Schedule A, line 1 . . . . . . . . . . . 7

Schedule F Losses Incurred—Section 832 (see instructions)1 Losses paid during the tax year (attach schedule) . . . . . . . . . . . . . . . . . . 1

2 Balance outstanding at the end of the current tax year for:

a Unpaid losses on life insurance contracts . . . . . . . . . . . . 2a

b Discounted unpaid losses . . . . . . . . . . . . . . . . 2b

c Total. Add lines 2a and 2b . . . . . . . . . . . . . . . . . . . . . . . . . 2c

3 Add lines 1 and 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Balance outstanding at the end of the preceding tax year for:

a Unpaid losses on life insurance contracts . . . . . . . . . . . . 4a

b Discounted unpaid losses . . . . . . . . . . . . . . . . 4b

c Total. Add lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . . . . 4c

5 Subtract line 4c from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . 5

6 Estimated salvage and reinsurance recoverable at the end of the preceding tax year . . . . . . . . 6

7 Estimated salvage and reinsurance recoverable at the end of the current tax year . . . . . . . . . 7

8 Losses incurred (line 5 plus line 6 less line 7) . . . . . . . . . . . . . . . . . . . . 8

9 Tax-exempt interest subject to section 832(b)(5)(B) . . . . . . . . . 910 Dividends-received deduction subject to section 832(b)(5)(B) (Schedule C, line

24) . . . . . . . . . . . . . . . . . . . . . . . 1011 The increase in policy cash value of section 264(f) policies as defined in section

805(a)(4)(F) . . . . . . . . . . . . . . . . . . . . . 11

12 Total. Add lines 9, 10, and 11 . . . . . . . . . . . . . . . . . . . . . . . . 12

13 Reduction of deduction under section 832(b)(5)(B). Multiply line 12 by .15 . . . . . . . . . . . 1314 Losses incurred deductible under section 832(c)(4). Subtract line 13 from line 8. Enter here and on

Schedule A, line 26 . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Form 1120-PC (2010)


Form 1120-PC (2010) Page 6 Schedule G Other Capital Losses (see instructions)

(Capital assets sold or exchanged to meet abnormal insurance losses and to pay dividends and similar distributions to policyholders.)

1 Dividends and similar distributions paid to policyholders . . . . . . . . . . . . . . . . 1

2 Losses paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Expenses paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Total. Add lines 1, 2, and 3 . . . . . . . . . . . . . . . . . . . . . . . . . 4

Note. Adjust lines 5 through 8 to cash method if necessary.

5 Interest received . . . . . . . . . . . . . . . . . . . 5

6 Dividends-received (Schedule C, line 14) . . . . . . . . . . . . 6

7 Gross rents, gross royalties, lease income, etc., and gross income from a trade or business other than an insurance business including income from Form 4797 (include gains for invested assets only) . . . . . . . . . . . . 7

8 Net premiums received . . . . . . . . . . . . . . . . . 8

9 Total. Add lines 5 through 8 . . . . . . . . . . . . . . . . . . . . . . . . . 910 Limitation on gross receipts from sales of capital assets. Line 4 less line 9. If zero or less, enter -0- . . . . 10

(a) Description of capital asset

(b) Date acquired

(c) Gross sales price


(e) Expense of sale

(f) Depreciation allowed (or allowable)

(g) Loss ((d) plus (e) less

the sum of (c) and (f))

11

12 Totals—column (c) must not be more than line 10. (Enter amount from column (g) in Schedule A, line 28, or Schedule B, line 15, whichever applies) . . .

Schedule H Special Deduction And Ending Adjusted Surplus for Section 833 Organizations (see instructions)

1 Amount expended on reimbursement for clinical services provided to enrollees, as reported under section 2718 of the Public Health Service Act (PHSA) (see instructions) . . . . . . . . . . . . . . 1

2 Total premium revenue as reported under section 2718 of the PHSA (see instructions) . . . . . . . 2

3a Percentage of total premium revenue expended on reimbursement for clinical services provided to enrollees.

Divide line 1 by line 2. Enter percentage

b Is the percentage reported on line 3a 85% or more?

Yes. Go to line 4.

No. Skip lines 4 through 7, and go to line 8.

4 Health care claims incurred during the tax year and liabilities incurred during the tax year under cost-plus contracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Expenses incurred during the tax year in connection with the administration, adjustment, or settlement of health care claims or in connection with the administration of cost-plus contracts . . . . . . . . . 5

6 Total. Add lines 4 and 5 . . . . . . . . . . . . . . . . . . . . . . . . . . 6

7 Multiply line 6 by .25 . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 Beginning adjusted surplus . . . . . . . . . . . . . . . . . . . . . . . . . 89 Special deduction. If you checked "No" on line 3b, enter -0- here, you cannot take the special deduction. All

others subtract line 8 from line 7. If zero or less, enter -0-. Enter amount here and on Schedule A, line 34a. (See instructions for limitation.) . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Net operating loss deduction (Schedule A, line 36b) . . . . . . . . . . . . . . . . . . 10

11 Net exempt income:

a Adjusted tax-exempt income . . . . . . . . . . . . . . . . . . . . . . . . 11a

b Adjusted dividends-received deduction . . . . . . . . . . . . . . . . . . . . . 11b

12 Taxable income (Schedule A, line 37) . . . . . . . . . . . . . . . . . . . . . . 1213 Ending adjusted surplus. Add lines 8 through 12 . . . . . . . . . . . . . . . . . . 13

Form 1120-PC (2010)


Form 1120-PC (2010) Page 7 Schedule I Other Information (see instructions)

Yes No1 Check method of accounting:

a Cash

b Accrual

c Other (specify)

2 Check box for kind of company:

a Mutual

b Stock

3 At the end of the tax year, did the corporation own, directly or indirectly, 50% or more of the voting stock of a domestic corporation? ( r rules of attribution, see section 267(c).) . . . . .

If “Yes,” attach a schedule showing: (a) name and employer identification number (EIN); (b) percentage owned; and (c) taxable income or (loss) before NOL and special deductions of such corporation for the tax year ending with or within your tax year.

4 Is the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? . . .

If “Yes,” enter name and EIN of the parent corporation

5 At the end of the tax year, did any individual, partnership, corporation, estate, or trust own, directly or indirectly, 50% or more of the corporation’s votinstock? (For rules of attribution, see section 267(c).)

If “Yes,” attach a schedule showing name and identifying number. (Do not include any information already entered in 4 above.)

Enter percentage owned

6 At any time during the tax year, did one foreign person own, directly or indirectly, at least 25% of: (a) the total voting power of all classes of stock of the corporation entitled to vote, or (b) the total value of all classes of stock of the corporation? If “Yes,”enter:

(a) Percentage owned and (b) Owner’scountry

Yes No

(c) The corporation may have to file Form 5472, Information Return of a 25% Foreign-Owned U.S. Corporation or a Foreign Corporation Engaged in a U.S. Trade or Business. Enter number of Forms 5472 attached

7 Has the corporation elected to use its own payout pattern for discounting unpaid losses and unpaid loss adjustment expenses? . . . . . . .

8a Enter the total unpaid losses shown on the corporation’s annual statement:

(1) for the current tax year: $(2) for the previous tax year: $

b Enter the total unpaid loss adjustment expenses shown on the corporation’s annual statement:

(1) for the current tax year: $(2) for the previous tax year: $

9 Does the corporation discount any of the loss reserves shown on its annual statement? . . .


11 If the corporation has an NOL for the tax year and is electing to forgo the carryback period, check here . . . . . . . . . .


12 Enter the available NOL carryover from prior tax years. (Do not reduce it by any deduction on line 36b, Schedule A.) . . . $

13 Is the corporation required to file Schedule UTP (Form 1120), Uncertain Tax Position Statement (see instructions)? If "Yes," complete and attach Schedule UTP . . . . . . . . . .

Form 1120-PC (2010)

X XEIN NAME

★


Form 1120-PC (2010) Page 8 Schedule L Balance Sheets per Books (All filers are required to complete this schedule.)

AssetsBeginning of tax year

(a) (b)

End of tax year

(c) (d)

1 Cash . . . . . . . . . . .

2a Trade notes and accounts receivable . .

b Less allowance for bad debts . . . . ( ) ( )

3 Inventories . . . . . . . . . .

4 U.S. government obligations . . . .

5 Tax-exempt securities (see instructions) .

6 Other current assets (attach schedule) . .

7 Loans to shareholders . . . . . .

8 Mortgage and real estate loans . . . .

9 Other investments (attach schedule) . .

10a Buildings and other depreciable assets .

b Less accumulated depreciation . . . . ( ) ( )

11a Depletable assets . . . . . . . .

b Less accumulated depletion . . . . . ( ) ( )

12 Land (net of any amortization) . . . .

13a Intangible assets (amortizable only) . .

b Less accumulated amortization . . . . ( ) ( )

14 Other assets (attach schedule) . . . .15 Total assets . . . . . . . .

Liabilities and Shareholders’ Equity16 Accounts payable . . . . . . . .

17 Mortgages, notes, bonds payable in less than 1 year

18 Insurance liabilities (see instructions) . .

19 Other current liabilities (attach schedule) .

20 Loans from shareholders . . . . . .

21 Mortgages, notes, bonds payable in 1 year or more

22 Other liabilities (attach schedule) . . .

23 Capital stock: a Preferred stock . . .

b Common stock . . .

24 Additional paid-in capital . . . . . .

25 Retained earnings—Appropriated (attach schedule)

26 Retained earnings—Unappropriated . .

27 Adjustments to shareholders’ equity (attach schedule)

28 Less cost of treasury stock . . . . ( ) ( ) 29 Total liabilities and shareholders’ equity . Schedule M-1 Reconciliation of Income (Loss) per Books with Income (Loss) per Return

Note: Schedule M-3 required instead of Schedule M-1 if total assets are $10 million or more—See instructions.

1 Net income (loss) per books . . . . .

2 Federal income tax per books . . . .

3 Excess of capital losses over capital gains4 Income subject to tax not recorded on

books this year (itemize)

5 Expenses recorded on books this year not deducted in this return (itemize)

a Depreciation $


c Travel and entertainment $

6 Add lines 1 through 5 . . . . . . .

7 Income recorded on books this year not included in this return (itemize)

a Tax-exempt interest $

8 Deductions in this tax return not charged against book income this year (itemize)

a Depreciation $


9 Add lines 7 and 8 . . . . . .10 Income (Schedule A, line 35 or Schedule B,

line 19, if applicable)—line 6 less line 9 .

Schedule M-2 Analysis of Unappropriated Retained Earnings per Books (line 26, Schedule L)1 Balance at beginning of year . . . .

2 Net income (loss) per books . . . . .3 Other increases (itemize)

4 Add lines 1, 2, and 3 . . . . . . .

5 Distributions: a Cash . . . .

b Stock . . . .

c Property . . .6 Other decreases (itemize)

7 Add lines 5 and 6 . . . . . .8 Balance at end of year (line 4 less line 7)

Form 1120-PC (2010)

BALANCE SHEET CODE P - ANNUAL STATEMENT CODE



PARENT CASHDISTRIBUTIONS


SCHEDULE M-3 (Form 1120-PC)


Net Income (Loss) Reconciliation for U.S. Property and Casualty Insurance Companies With Total Assets of $10 Million or More

Attach to Form 1120-PC. See separate instructions.

OMB No. 1545-0127

2010Check applicable box(es): (1) Non-consolidated return (2) Consolidated return (Form 1120-PC only)

(3) Mixed 1120/L/PC group (4) Dormant subsidiaries schedule attached

Name of corporation (common parent, if consolidated return) Employer identification number

Part I Financial Information and Net Income (Loss) Reconciliation (see instructions)1 a Did the corporation file SEC Form 10-K for its income statement period ending with or within this tax year?

Yes. Skip lines 1b and 1c and complete lines 2a through 11 with respect to that SEC Form 10-K.No. Go to line 1b. See instructions if multiple non-tax-basis income statements are prepared.


c Did the corporation prepare a non-tax-basis income statement for that period?Yes. Complete lines 2a through 11 with respect to that income statement.No. Skip lines 2a through 3c and enter the corporation’s net income (loss) per its books and records on line 4a.

2 a Enter the income statement period: Beginning Endingb Has the corporation’s income statement been restated for the income statement period on line 2a?



3 a Is any of the corporation’s voting common stock publicly traded?Yes.No. If “No,” go to line 4a.

b Enter the symbol of the corporation’s primary U.S. publicly traded voting commonstock . . . . . . . . . . . . . . . . . . . . . . . . . .

c Enter the nine-digit CUSIP number of the corporation’s primary publicly traded voting common stock . . . . . . . . . . . . . . . . . . . . . . .

4 a Worldwide consolidated net income (loss) from income statement source identified in Part I, line 1 . 4a b Indicate accounting standard used for line 4a (see instructions):

(1) GAAP (2) IFRS (3) Statutory (4) Other (specify)5 a Net income from nonincludible foreign entities (attach schedule) . . . . . . . . . . . . . 5a ( )

b Net loss from nonincludible foreign entities (attach schedule and enter as a positive amount) . . . 5b6 a Net income from nonincludible U.S. entities (attach schedule) . . . . . . . . . . . . . 6a ( )

b Net loss from nonincludible U.S. entities (attach schedule and enter as a positive amount) . . . . 6b7 a Net income (loss) of other includible foreign disregarded entities (attach schedule) . . . . . . . 7a

b Net income (loss) of other includible U.S. disregarded entities (attach schedule) . . . . . . . 7bc Net income (loss) of other includible corporations (attach schedule) . . . . . . . . . . . . 7c



b Other statutory accounting adjustments to reconcile to line 11 (attach schedule) . . . . . . . 10bc Other adjustments to reconcile to amount on line 11 (attach schedule) . . . . . . . . . . . 10c

11 Net income (loss) per income statement of includible corporations. Combine lines 4a through 10c Note. Part I, line 11, must equal the amount on Part II, line 30, column (a) and on Schedule M-2, line 2.

11


Total Assets Total Liabilitiesa Included on Part I, line 4 . . . . . b Removed on Part I, line 5 . . . . c Removed on Part I, line 6 . . . . d Included on Part I, line 7 . . . . .

For Paperwork Reduction Act Notice, see the Instructions for Form 1120-PC. Cat. No. 39664A Schedule M-3 (Form 1120-PC) 2010

M3-RTN-CD REV-YR-SCHM3


Schedule M-3 (Form 1120-PC) 2010 Page 2 Name of corporation (common parent, if consolidated return) Employer identification number


Check if a sub-consolidated: (6) 1120-PC group (7) 1120-PC eliminations


Part II Reconciliation of Net Income (Loss) per Income Statement of Includible Corporations With Taxable Income per Return (see instructions)





(d) Income (Loss) per Tax Return

1 Income (loss) from equity method foreign corporations 2 Gross foreign dividends not previously taxed . . . 3 Subpart F, QEF, and similar income inclusions . .4 Section 78 gross-up . . . . . . . . . . . 5 Gross foreign distributions previously taxed . . . 6 Income (loss) from equity method U.S. corporations . .7 U.S. dividends not eliminated in tax consolidation . 8 Minority interest for includible corporations . . . . 9 Income (loss) from U.S. partnerships . . . . . .

10 Income (loss) from foreign partnerships . . . . . 11 Income (loss) from other pass-through entities . . 12 Items relating to reportable transactions (attach details) 13 Interest income (attach Form 8916-A) . . . . . 14 Hedging transactions . . . . . . . . . . . 15 Mark-to-market income (loss) . . . . . . . .16 Premium income (attach schedule) . . . . . .17 Sale versus lease (for sellers and/or lessors) . . . 18 Section 481(a) adjustments . . . . . . . . . 19 Income from a special loss discount account . . . 20 Income recognition from long-term contracts . . . 21 Original issue discount and other imputed interest .22 Reserved for future use . . . . . . . . . .23a

Income statement gain/loss on sale, exchange, abandonment, worthlessness, or other disposition of assets other than pass-through entities . . . . .


c

Gross capital losses from Schedule D, excluding amounts from pass-through entities, abandonment losses, and worthless stock losses . . . . . .

d

Net gain/loss reported on Form 4797, line 17, excluding amounts from pass-through entities, abandonment losses, and worthless stock losses .

e Abandonment losses . . . . . . . . . . .f Worthless stock losses (attach details) . . . . .g Other gain/loss on disposition of assets . . . . .

24 Capital loss limitation and carryforward used . . .25 Other income (loss) items with differences (attach schedule)26 Total income (loss) items. Combine lines 1 through 25 27 Total expense/deduction items (from Part III, line 41)

28 Other items with no differences . . . . . . . 29a Mixed groups, see instructions. All others, combine

lines 26 through 28 . . . . . . . . . . .

b 1120 subgroup reconciliation totals . . . . . .c Life insurance subgroup reconciliation totals . . .

30 Reconciliation totals. Combine lines 29a through 29cNote. Line 30, column (a) must equal the amount on Part I, line 11, and column (d) must equal Form 1120-PC, Schedule A, line 35.

Schedule M-3 (Form 1120-PC) 2010


Schedule M-3 (Form 1120-PC) 2010 Page 3 Name of corporation (common parent, if consolidated return) Employer identification number


Check if a sub-consolidated: (6) 1120-PC group (7) 1120-PC eliminations


Part III Reconciliation of Net Income (Loss) per Income Statement of Includible Corporations With Taxable Income per Return—Expense/Deduction Items (see instructions)





(d) Deduction per

Tax Return

1 U.S. current income tax expense . . . . . . . 2 U.S. deferred income tax expense . . . . . . 3 State and local current income tax expense . . . 4 State and local deferred income tax expense . . . 5 Foreign current income tax expense (other than

foreign withholding taxes) . . . . . . . . .

6 Foreign deferred income tax expense . . . . . 7 Foreign withholding taxes . . . . . . . . . 8 Stock option expense . . . . . . . . . . . 9 Other equity-based compensation . . . . . . .

10 Meals and entertainment . . . . . . . . . . 11 Fines and penalties . . . . . . . . . . . 12 Judgments, damages, awards, and similar costs . . 13 Parachute payments . . . . . . . . . . . 14 Compensation with section 162(m) limitation . . . 15 Pension and profit-sharing . . . . . . . . . 16 Other post-retirement benefits . . . . . . . . 17 Deferred compensation . . . . . . . . . . 18 Charitable contribution of cash and tangible property 19 Charitable contribution of intangible property . . . 20 Charitable contribution limitation/carryforward . . . 21 Write-off of premium receivables . . . . . . . 22 Guarantee fund assessments . . . . . . . .

23 Current year acquisition or reorganization investment banking fees . . . . . . . . . . . . . .

24 Current year acquisition or reorganization legal and accounting fees . . . . . . . . . . . . .

25 Current year acquisition/reorganization other costs . 26 Amortization of acquisition, reorganization, and start-up costs 27 Amortization/impairment of goodwill, insurance in

force, and ceding commissions . . . . . . .

28 Other amortization or impairment write-offs . . . . 29 Discounting of unpaid losses (section 846) (attach schedule) 30 Reduction of loss deduction (section 832(b)(5)(B)) .

31 Depreciation . . . . . . . . . . . . . . 32 Bad debt expense and/or agency balances written off 33 Deduction from a special loss discount account . . 34 Corporate owned life insurance premiums . . . . 35 Purchase versus lease (for purchasers and/or lessees)36 Interest expense (attach Form 8916-A) . . . . . 37 Domestic production activities deduction . . . .38 Research and development costs (attach schedule) .39 Section 118 exclusion (attach schedule) . . . . .40 Other expense/deduction items with differences

(attach schedule) . . . . . . . . . . . .

41

Total expense/deduction items. Combine lines 1 through 40. Enter here and on Part II, line 27, reporting positive amounts as negative and negative amounts as positive .

Schedule M-3 (Form 1120-PC) 2010

★


Form 1120-REITDepartment of the Treasury Internal Revenue Service

U.S. Income Tax Return for Real Estate Investment Trusts

For calendar year 2010 or tax year beginning , 2010, ending , 20


OMB No. 1545-1004

2010

Please Type

or Print

Name

Number, street, and room or suite no. (If a P.O. box, see instructions.)


A Year of REIT status election

B Check if a:1 REIT with 100%

owned subsidiaries (see instructions)

2 Personal holding co. (attach Sch. PH)

C Employer identification number

D Date REIT established

E Total assets (see instructions)

$ F Check applicable box(es) (1) Final return (2) Name change (3) Address change (4) Amended return

G Identify the type of REIT (see instructions): (1) Equity REIT (2) Mortgage REIT

H PBA code (see instructions)

Part I—Real Estate Investment Trust Taxable Income (see instructions)Income (EXCLUDING income required to be reported in Part II or Part IV)

1 Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Gross rents from real property . . . . . . . . . . . . . . . . . . . . . . 3 4 Other gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 Capital gain net income (attach Schedule D (Form 1120)) . . . . . . . . . . . . . 5 6 Net gain or (loss) from Form 4797, Part II, line 17 (attach Form 4797) . . . . . . . . . 6 7 Other income (see instructions—attach schedule) . . . . . . . . . . . . . 7 8 Total income. Add lines 1 through 7 . . . . . . . . . . . . . . . . . . 8

Deductions (EXCLUDING deductions directly connected with income required to be reported in Part II or Part IV)9 Compensation of officers . . . . . . . . . . . . . . . . . . . . . . . 9

10 Salaries and wages (less employment credits) . . . . . . . . . . . . . . . . 10 11 Repairs and maintenance . . . . . . . . . . . . . . . . . . . . . . . 11 12 Bad debts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 13 Rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Taxes and licenses . . . . . . . . . . . . . . . . . . . . . . . . . . 14 15 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 16 Depreciation (attach Form 4562) . . . . . . . . . . . . . . . . . . . . . 16 17 Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 18 Other deductions (see instructions—attach schedule) . . . . . . . . . . . . . 18 19 19 Total deductions. Add lines 9 through 18 . . . . . . . . . . . . . . . . 20 Taxable income before net operating loss deduction, total deduction for dividends paid, and

section 857(b)(2)(E) deduction. Subtract line 19 from line 8 . . . . . . . . . . . . . 20 21 Less: a Net operating loss deduction (see instructions) . . . . 21a

b Total deduction for dividends paid (Schedule A, line 6) 21bc Section 857(b)(2)(E) deduction (Schedule J, lines 2c, 2e, and 2f) 21c 21d

Tax and Payments22 Real estate investment trust taxable income. Subtract line 21d from line 20 . . . . . . 22 23 Total tax (Schedule J, line 7) . . . . . . . . . . . . . . . . . . . . . . 23 24 Payments: a 2009 overpayment credited to 2010 24a

b 2010 estimated tax payments . . . . 24bc Less 2010 refund applied for on Form 4466 24c )( d Bal 24de Tax deposited with Form 7004 . . . . . . . . . . . . . . 24ef Credits: (1) Form 2439 (2) Form 4136 24fg Refundable credits from Form 3800, line 19c, and Form 8827, line 8c . 24g 24h

25 Estimated tax penalty (see instructions). Check if Form 2220 is attached . . . . . 25 26 Tax due. If line 24h is smaller than the total of lines 23 and 25, enter amount owed . . . . 26 27 Overpayment. If line 24h is larger than the total of lines 23 and 25, enter amount overpaid . . 27 28 Enter amount of line 27 you want: Credited to 2011 estimated tax Refunded 28

Sign Here






PTIN

Firm’s name

Firm’s address

Firm's EIN

Phone no.

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 64114F Form 1120-REIT (2010)

PRIOR YEAR EIN

INCOME ADJUSTMENT

SOI INDUSTRY CODEPBA CODE

X

TOTAL AMORTIZATIONDEDUCTION ADJUSTMENT

TAX PAYMENTADJUSTMENT

MERGE EIN


Form 1120-REIT (2010) Page 2

Part II—Tax on Net Income From Foreclosure Property (Section 856(e)) (see instructions)

1 Net gain or (loss) from the sale or other disposition of foreclosure property described in section1221(a)(1) (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . 1

2 Gross income from foreclosure property (see instructions—attach schedule) . . . . . . . 2 3 Total income from foreclosure property. Add lines 1 and 2 . . . . . . . . . . . . . 3 4 Deductions directly connected with the production of income shown on line 3 (attach schedule) 4 5 Net income from foreclosure property. Subtract line 4 from line 3 . . . . . . . . . . 5 6 Tax on net income from foreclosure property. Multiply line 5 by 35%. Enter here and on

Schedule J, line 2b . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Part III—Tax for Failure To Meet Certain Source-of-Income Requirements (Section 857(b)(5)) (see instructions)

1 a Enter total income from Part I, line 8 . . . . . . . . . . 1a b Enter total income from foreclosure property from Part II, line 3 . 1bc Total. Add lines 1a and 1b . . . . . . . . . . . . . . . . . . . . . . . 1c

2 a Enter income from hedging transactions referred to in section 856(c)(5)(G) . . . . . . . . . . . . . . . . . . 2a

b Subtract line 2a from line 1c . . . . . . . . . . . . 2bc Multiply line 2b by 95% . . . . . . . . . . . . . . . . . . . . . . . . 2c

3 Enter income on line 1c from sources referred to in section 856(c)(2) . . . . . . . . . 3 4 Subtract line 3 from line 2c. (If zero or less, enter -0-.) . . . . . . . . . . . . . . 4 5 Multiply line 1c by 75% . . . . . . . . . . . . . . . . . . . . . . . . 5 6 Enter income on line 1c from sources referred to in section 856(c)(3) . . . . . . . . . 6 7 Subtract line 6 from line 5. (If zero or less, enter -0-.) . . . . . . . . . . . . . . 7 8 Enter the greater of line 4 or line 7. (If line 8 is zero, do not complete the rest of Part III.) . . 8 9 Enter the amount from Part I, line 20 . . . . . . . . . . . . . . . . . . . . 9

10 Enter the net capital gain from Schedule D (Form 1120), line 13 . . . . . . . . . . . 10 11 Subtract line 10 from line 9 . . . . . . . . . . . . . . . . . . . . . . . 11 12a Enter total income from Part I, line 8 . . . . . . . . . . 12a

b Enter the net short-term capital gain from Schedule D (Form 1120), line 5. (If line 5 is a loss, enter -0-.) . . . . . . . . . . 12b

c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . . 12c13 Enter capital gain net income from Part I, line 5 . . . . . . . . . . . . . . . . 13 14 Subtract line 13 from line 12c . . . . . . . . . . . . . . . . . . . . . . 14 15 Divide line 11 by line 14. Carry the result to five decimal places . . . . . . . . . . . 15 16 Section 857(b)(5) tax. Multiply line 8 by line 15. Enter here and on Schedule J, line 2c . . . 16

Part IV—Tax on Net Income From Prohibited Transactions (see instructions)

1 Gain from sale or other disposition of section 1221(a)(1) property (other than foreclosure property) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Deductions directly connected with the production of income shown on line 1 . . . . . . 2 3 Tax on net income from prohibited transactions. Subtract line 2 from line 1. Enter here and

on Schedule J, line 2d . . . . . . . . . . . . . . . . . . . . . . . . 3

Schedule A Deduction for Dividends Paid (see instructions)

1

Dividends paid (other than dividends paid after the end of the tax year). Do not include dividends considered paid in the preceding tax year under section 857(b)(9) or 858(a), or deficiencydividends as defined in section 860 . . . . . . . . . . . . . . . . . . . . 1

2 Dividends paid in the 12-month period following the close of the tax year under a section858(a) election to treat the dividends as paid during the tax year . . . . . . . . . . . 2

3 Dividends declared in October, November, or December deemed paid on December 31 under section 857(b)(9) . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Consent dividends (attach Forms 972 and 973) . . . . . . . . . . . . . . . . 4 5 Total dividends paid. Add lines 1 through 4 . . . . . . . . . . . . . . . . . . 5 6

Total deduction for dividends paid. If there is net income from foreclosure property on Part II, line 5, see instructions for limitation on the deduction for dividends paid. Otherwise, enter thetotal dividends paid from line 5 here and on line 21b of page 1 . . . . . . . . . . . 6

Form 1120-REIT (2010)


Form 1120-REIT (2010) Page 3Schedule J Tax Computation (see instructions)1 Check if the REIT is a member of a controlled group (attach Schedule O (Form 1120))

Important: Members of a controlle roup, see instructions.2 a Tax on REIT taxable income . . . . . . . . . . . 2a

b Tax from Part II, line 6 . . . . . . . . . . . . . . . 2bc Tax from Part III, line 16 . . . . . . . . . . . . . . 2c d Tax from Part IV, line 3 . . . . . . . . . . . . . . 2de Tax imposed under section 857(b)(7)(A) (see instructions) . . . 2e f Tax imposed under sections 856(c)(7) and 856(g)(5) . . 2f g Alternative minimum tax (attach Form 4626) . . . . . . . 2gh Income tax. Add lines 2a through 2g . . . . . . . . . . . . . . . . . . . . 2h

3 a Foreign tax credit (attach Form 1118) . . . . . . . . 3a b Credit from Form 8834, line 29 . . . . . . . . . . . . 3bc General business credit (attach Form 3800) . . . . . . . 3c d Other credits (attach schedule—see instructions) . . . . . . 3de Total credits. Add lines 3a through 3d . . . . . . . . . . . . . . . . . . 3e

4 Subtract line 3e from line 2h . . . . . . . . . . . . . . . . . . . . . 4 5 Personal holding company tax (attach Sched e PH (Form 1120)) . . . . . . . . . . 5 6 Other taxes. Check if from: orm 4255 Form 8611 Other (attach schedule) . . . 6 7 Total tax. Add lines 4 through 6. Enter here and on line 23, page 1 . . . . . . . . . 7

Schedule K Other Information (see instructions)1 Check method of accounting: Yes No

a Cash

b Accrual

c Other (specify) 2

At the end of the tax year, did the REIT own, directly or indirectly, 50% or more of the voting stock of a domestic corporation? (For rules of attribution, see section 267(c).) . . . . . .

If “Yes,” attach a schedule showing: (a) name and employer identification number (EIN), (b) percentage owned, and (c) taxable income or (loss) before NOL and special deductions of such corporation for the tax year ending with or within your tax year.

3 Is the REIT a subsidiary in a parent-subsidiary controlled group? . . . . . . . . . .If “Yes,” enter the name and EIN of the parent corporation

4

At the end of the tax year, did any individual, partnership, corporation, estate, or trust own, directly or indirectly, 50% or more of the REIT’s voting stock? (For rules of attributi , see section 856(h).) . . . . . . . . . . . .

If “Yes,” attach a schedule showing name and identifying number. (Do not include any information already entered in 3 above.) Enter percentage owned

5 At any time during the tax year, did one foreign person own, directly or indirectly, at least 25% of:

Yes No

(a) the total voting power of all classes of stock of the REIT entitled to vote, or (b) the total value all classes of stock of the REIT? If “Yes,” enter: .

a Percentage owned b Owner’s country

c The REIT may have to file Form 5472. Enter number of Forms 5472 attached

6

During this tax year, did the REIT pay dividends (other than stock dividends and distributions in exchange for stock) in excess of the REIT’s current and accumulated earnings d profits? (See sections 301 and 316.) . . . . . . . .

If “Yes,” file Form 5452.

7 Check this box if the REIT issued publicly offered debt instruments with original issue discount

If so, the REIT may have to file Form 8281.


9

Enter the available NOL carryover from prior tax years. (Do not reduce it by any deduction on line 21a, page 1.) $

Form 1120-REIT (2010)



EINNAME


INDIAN EMPLOYMENT CREDIT QUALIFIED ELECTRIC VEHICLE CREDIT



Form 1120-REIT (2010) Page 4 Schedule L Balance Sheets per Books Beginning of tax year End of tax year

( ) ( )

( ) ( )

( ) ( )

( ) ( )


1 Cash . . . . . . . . . . . 2a Trade notes and accounts receivable .b Less allowance for bad debts . . .

3 U.S. government obligations . . .4 Tax-exempt securities (see instructions) 5 Other current assets (attach schedule) 6 Loans to shareholders . . . . .7 Mortgage and real estate loans . .8 Other investments (attach schedule) .9a Buildings and other depreciable assetsb Less accumulated depreciation . .

10 Land (net of any amortization) . . .11a Intangible assets (amortizable only) .

b Less accumulated amortization . .12 Other assets (attach schedule) . . .13 Total assets . . . . . . . . .

Liabilities and Shareholder's Equity14 Accounts payable . . . . . . .15 Mortgages, notes, bonds payable in less than 1 year16 Other current liabilities (attach schedule)17 Loans from shareholders . . . . .18 Mortgages, notes, bonds payable in 1 year or more19 Other liabilities (attach schedule) . .20 Capital stock: a Preferred stock .

b Common stock .21 Additional paid-in capital . . . . .22 Retained earnings—Appropriated (attach schedule)23 Retained earnings—Unappropriated .24 Adjustments to shareholders' equity

(see instructions—attach schedule) .

25 Less cost of treasury stock . . . .26 Total liabilities and shareholders' equity Schedule M-1 Reconciliation of Income (Loss) per Books With Income per Return (see instructions)

1 Net income (loss) per books . . . .2a Federal income tax $

b

Less: Section 856(c)(7) tax, 856(g)(5) tax, 857(b)(5) tax, section 857(b)(7) tax, and built-in gains tax ( ) $

c Balance . . . . . . . . . 3 Excess of capital losses over capital gains4 Income subject to tax not recorded on

books this year (itemize):5 Expenses recorded on books this year

not deducted on this return (itemize):

a Depreciation . . . $

b Section 4981 tax . $

c Travel and entertainment $

6 Add lines 1 through 5 . . . . . .

7

Income recorded on books this year not included on this return (itemize): Tax-exempt interest $

8

Deductions on this return not charged against book income this year (itemize):

a Depreciation . $b Net operating loss deduction (line

21a, page 1) $c Deduction for dividends paid (line

21b, page 1) $

9 Net income from foreclosure property10 Net income from prohibited transactions11 Add lines 7 through 10 . . .12 REIT taxable income (line 22,

page 1)— line 6 less line 11 .

Schedule M-2 Analysis of Unappropriated Retained Earnings per Books (Schedule L, line 23)1 Balance at beginning of year . . .2 Net income (loss) per books . . . .3 Other increases (itemize):

4 Add lines 1, 2, and 3 . . . . . .

5 Distributions: a Cash . . . b Stock . . c Property . .

6 Other decreases (itemize):7 Add lines 5 and 6 . . . . .8 Balance at end of year (line 4 less line 7)

Form 1120-REIT (2010)

BALANCE SHEET CODE




Form 1120-RIC


U.S. Income Tax Return for Regulated Inves nt Companies

For calendar year 2010 or tax year beginning , 2010, and ending , 20


OMB No. 1545-1010

2010

Please type or print

Name of fund

Number, street, and room or suite no. (If a P.O. box, see instructions.)

City or town, ate, and ZIP code

A Year of RIC status election

B Date fund was established (see instructions)

C Employer identification number

D Total assets (see instructions)

$

E Check applicable boxes: (1) Final return (2) Name change (3) Address change (4) Amended return

F Check if the fund is a personal holding company (attach Sch. PH) or if the fund is not in compliance with Regs. sec. 1.852-6 for this tax year

Part I—Investment Company Taxable Income (see instructions)

Inco

me

1 Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Net foreign currency gain or (loss) from section 988 transactions (attach schedule) . . . . . 3 4 Payments with respect to securities loans . . . . . . . . . . . . . . . . . . 4 5 Excess of net short-term capital gain over net long-term capital loss from Schedule D (Form 1120),

line 12 (attach Schedule D (Form 1120)) . . . . . . . . . . . . . . . . . . 5 6 Net gain or (loss) from Form 4797, Part II, line 17 (attach Form 4797) . . . . . . . . . 6 7 Other income (see instructions—attach schedule) . . . . . . . . . . . . . . 7 8 Total income. Add lines 1 through 7 . . . . . . . . . . . . . . . . . 8

Ded

ucti

ons

(see

inst

ruct

ions

)

9 Compensation of officers (Schedule E, line 2) . . . . . . . . . . . . . . . . 9 10 Salaries and wages (less employment credits) . . . . . . . . . . . . . . . . 10 11 Rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Taxes and licenses . . . . . . . . . . . . . . . . . . . . . . . . . 12 13 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Depreciation (attach Form 4562) . . . . . . . . . . . . . . . . . . . . . 14 15 Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 16 Registration fees . . . . . . . . . . . . . . . . . . . . . . . . . 16 17 Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 18 Accounting and legal services . . . . . . . . . . . . . . . . . . . . . 18 19 Management and investment advisory fees . . . . . . . . . . . . . . . . . 19 20 Transfer agency, shareholder se cing, and custodian fees a expenses . . . . . . . 20 21 Reports to shareholders . . . . . . . . . . . . . . . . . . . . . 21 22 Other deductions (see instructions—attach schedule) . . . . . . . . . . . . . . 22 23 Total deductions. Add lines 9 through 22 . . . . . . . . . . . . . . . . 23 24 Taxable income before deduction for dividends paid. Subtract line 23 from line 8 . . . . . 24 25 Less: Deduction for dividends paid (Schedule A, line 7a) . . . . . . . . . . . . . 25

Tax

and

Pay

men

ts

26 Investment company taxable income. Subtract line 25 from line 24 . . . . . . . . . 26 27 Total tax (Schedule J, line 7) . . . . . . . . . . . . . . . . . . . . . . 27 28a 2009 overpayment credited to 2010 . 28a

b 2010 estimated tax payments . . 28bc Less 2010 refund applied for on Form 4466 28c ( ) dBal 28de Tax deposited with Form 7004 . . . . . . . . . . . . . 28ef Credit for tax paid on undistributed capital gains (attach Form 2439) . 28fg Credit for federal tax paid on fuels (attach Form 4136) . . . . . . 28gh Refundable credits from Form 3800, line 19c, and Form 8827, line 8c . 28h 28i

29 Estimated tax penalty (see instructions). Check if Form 2220 is attached . . . . . 29 30 Amount owed. If line 28i is smaller than the total of lines 27 and 29, enter amount owed . . . 30 31 Overpayment. If line 28i is larger than the total of lines 27 and 29, en r amount overpaid . . . 31 32 Enter amount from line 31: Credited to 2011 estimated tax Refunded 32

Sign Here






PTIN

Firm’s name

Firm’s address

Firm's EIN

Phone no.

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 64140B Form 1120-RIC (2010)

SOI INDUSTRY CODE

INCOME ADJUSTMENT

TOTAL AMORTIZATION DEDUCTION ADJUSTMENT

INCLUDED INLINE 22OTHERDEDUCTIONS

MERGE EIN

PBA CODE

PY-EIN


Form 1120-RIC (2010) Page 2 Part II—Tax on Undistributed Net Capital Gain Not Designated Under Section 852(b)(3)(D)

1 Net capital gain from Schedule D (Form 1120), line 13 (attach Schedule D (Form 1120)) . . . . . 12 Capital gain dividends from Schedule A, line 7b . . . . . . . . . . . . . . . . . 23 Amount subject to tax. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . 34 Capital gains tax. Multiply line 3 by 35% (.35). Enter tax here and on line 2b, Schedule J . . . . 4

Schedule A Deduction for Dividends Paid (Do not include exempt-interest dividends or capital gain dividends reported on Form 2438, line 9b; see instructions.)

1 Dividends paid (other than dividends paid after the end of the tax year). Do not include dividends deemed paid in the preceding tax year under section 852(b)(7) or 855(a), or deficiency dividends as defined in section 860(f) . .

(a) Ordinary dividends (b) Capital gain dividends

12 Dividends paid in the 12-month period following the close of the tax year that

the fund elects to treat as paid during the tax year under section 855(a) . . 23 Dividends declared in October, November, or December and deemed

paid on December 31 under section 852(b)(7) . . . . . . . . . 34 Consent dividends (section 565) (attach Forms 972 and 973) . . . . 45 Foreign tax paid deduction (section 853(b)(1)(B)), if applicable . . . . 56 Credits from tax credit bonds distributed to shareholders (see instructions) . 67 Deduction for dividends paid:a Ordinary dividends. Add lines 1 through 6 of column (a). Enter here and on line 25, Part I 7ab Capital gain dividends. Add lines 1 through 4 of column (b). Enter here

and on line 2, Part II, above . . . . . . . . . . . . . . 7bSchedule B Information Required With Respect to Income From Tax-Exempt Obligations1 Did the fund qualify under section 852(b)(5) to pay exempt-interest dividends for 2009? . . . . . . . Yes No

If “Yes,” complete lines 2 through 5.2 Amount of interest excludible from gross income under section 103(a) . . . . . . . . . . 23 Amounts disallowed as deductions under sections 265 and 171(a)(2) . . . . . . . . . . 34 Net income from tax-exempt obligations. Subtract line 3 from line 2 . . . . . . . . . . . 45 Amount of line 4 designated as exempt-interest dividends . . . . . . . . . . . . . . 5

Schedule E Compensation of Officers (see instructions for line 9, Part I)Note. Complete Schedule E only if total receipts (line 8, Part I, plus net capital gain from line 1, Part II, and line 9a, Form 2438) are $500,000 or more.

(a) Name of officer(b) Social security

number(c) Percent of time

devoted to business(d) Percent of fund

stock owned(e) Amount of compensation

1 % %% %

2 Total compensation of officers. Enter here and on line 9, Part I . . . . . . . . . . 2Schedule J Tax Computation (see instructions)1 Check if the fund is a member of a controlled gro p (attach Schedule O (Form 1120)) . . . 2a Tax on investment company taxable income . . . . . . . 2ab Tax on undistributed net capital gain (from Part II, line 8) . . . . . 2bc Alternative minimum tax (attach Form 4626) . . . . . . . . . 2cd Income tax. Add lines 2a through 2c . . . . . . . . . . . . . . . . . . . 2d

3a Foreign tax credit (attach Form 1118) . . . . . . . . . . 3ab Credit from Form 8834, line 29 . . . . . . . . . . . . . 3bc General business credit (attach Form 3800) . . . . . . . . . 3cd Other credits (attach schedule—see instructions) . . . . . . . 3de Total credits. Add lines 3a through 3d . . . . . . . . . . . . . . . . . . . 3e

4 Subtract line 3e from line 2d . . . . . . . . . . . . . . . . . . . . . . 45 Personal holding company tax (attach Schedule PH (Form 1120)) . . . . . . . . . . . 56 Other taxes. Check if from: Form 4255 Other (attach schedule) . . . . 67 Total tax. Add lines 4 through 6. Enter here and on page 1, line 27 . . . . . . . . . . 7

Form 1120-RIC (2010)



RECAPTURE TAXES FROM LINE 6 "OTHER" : INDIAN EMPLOYMENT CREDIT


QUALIFIED ELECTRIC VEHICLE CREDIT



Form 1120-RIC (2010) Page 3 Schedule K Other Information (see instructions) Yes No

1 Check method of accounting:a Cashb Accrualc Other (specify)

2 At the end of the tax year, did the RIC own, directly or indirectly, 50% or more of the voting stock of a domestic corporation?(For rules of attribution, see section 267(c).)If “Yes,” attach a schedule showing (a) name and identification number, (b) percentage owned, and (c) taxable income or (loss) before a net operating loss (NOL) and special deductions of such corporation for the tax year ending with or within your tax year.

3 Is the RIC a subsidiary in a parent-subsidiary controlled group? . . . . . . . . . . . . . . . . . . .

If “Yes,” enter the employer identification number and the name of the parent corporation

4 At the end of the tax year, did any individual, partnership, corporation, estate, or trust own, directly or indirectly, 50% or more of the RIC’s voting stock? (For rules of attribution, see section 267(c).) . . . . . . . . . . . . . .

If “Yes,” attach a schedule showing name and identification number. (Do not include any information already entered in 3 above.) Enter percentage owned

5 At any time during the tax year, did one foreign person own, directly or indirectly, at least 25% of:a The total voting power of all classes of stock of the fund enti d to vote or b The total value of all classes of stock of the fund? . . . . . . . . . . . . . . . . . . . . . .

If “Yes,” enter:

(1) Percentage owned (2) Owner’s country The fund may have to file Form 5472. Enter number of Forms 5472 attached

6 During this tax year, did the fund pay dividends (other than stock dividends and distributions in ex nge for stock) in excess of the fund’s current and accumulated earnings and profits? (see sections 301 and 316) . . . . . . . . . .

If “Yes,” file Form 5452.

7 Check this box if the fund issued publicly offered debt instruments with original issue discount . . . . . . . If checked, the fund may have to file Form 8281.

8 Enter the amount of tax-exempt interest received or accrued during the tax year. $

9 If this return is being filed for a series fund (as defined in section 851(g)(2)), entera The name of the regulated investment company in which the fund is a series b The date the regulated investment company was incorporated or organized

10

Section 853 election. Check this box if the fund meets the requirements of section 853(a) and section 901(k) and elects to pass through the deduction or credit for foreign taxes it paid to its shareholders. See the instructions for additional details and requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11 Section 853A election. Check this box if the fund elects under section 853A to pass through credits from tax credit bonds to its shareholders (see instructions) . . . . . . . . . . . . . . . . . . . . . . .

12

Regulations section 1.852-11 election. Check this box if, for purposes of computing taxable income, the fund elects under Regulations section 1.852-11(f)(1) to defer all or part of its post-October capital loss or post-October currency loss for this tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the election is made, enter the amounts deferred:a Post-October capital loss b Post-October currency loss

Form 1120-RIC (2010)

NAMEEIN


Form 1120-RIC (2010) Page 4 Schedule L Balance Sheets per Books Beginning of tax year End of tax year

( ) ( )

( ) ( )

( ) ( )

( ) ( )


1 Cash . . . . . . . . . . . 2a Trade notes and accounts receivable .b Less allowance for bad debts . . . .

3 U.S. government obligations . . . .4 Tax-exempt securities (see instructions) 5 Other current assets (attach schedule) .6 Loans to shareholders . . . . . .7 Mortgage and real estate loans . . .8 Other investments (attach schedule) . .9a Buildings and other fixed depreciable assetsb Less accumulated depreciation . . .

10 Land (net of any amortization) . . . .11a Intangible assets (amortizable only) . .

b Less accumulated amortization . . .12 Other assets (attach schedule) . .13 Total assets . . . . . . . . .

Liabilities and Shareholder's Equity

14 Accounts payable . . . . . . .15 Mortgages, notes, bonds payable in less than 1 year.16 Other current liabilities (attach schedule)17 Loans from shareholders . . . . .18 Mortgages, notes, bonds payable in 1 year or more19 Other liabilities (attach schedule) . . .20 Capital stock . . . . . . . . .21 Additional paid-in capital . . . . .22 Retained earnings - Appropriated (attach schedule)23 Retained earnings - Unappropriated . .24 Adjustments to shareholders' equity (attach schedule)25 Less cost of treasury stock . . . .26 Total liabilities and shareholders' equity

Note: The fund is not required to complete Schedules M-1 and M-2 if the total assets on Schedule L, line 13, column (d), are less than $25,000.

Schedule M-1 Reconciliation of Income (Loss) per Books With Income per Return (see instructions)1 Net income (loss) per books . . . .2 Federal income tax (less built-in gains tax)3 Excess of capital losses over capital gain4 Income subject to tax not recorded on

books this year (itemize):


a Depreciation . . . $b Expenses allocable to tax-exempt interest

income . . . . . $

c Section 4982 tax . . $

d Travel and entertainment $



Tax exempt interest $

8 Deductions on this return not charged against book income this year (itemized):

a Depreciation . . . $

b Deduction for dividends paid (line 25, Part I) . $

9 Net capital gain from Form 2438, line 9a10 If the fund did not file Form 2438, enter

the net capital gain from Schedule D (Form 1120), line 13. Otherwise, enter -0-

11 Add line 7 through 10 . . . .12 Investment company taxable income

(line 26, Part I)-line 6 less line 11 .

Schedule M-2 Analysis of Unappropriated Retained Earnings per Books (Schedule L, line 23)1 Balance at beginning of year . . . .2 Net income (loss) per books . . . .3 Other increases (itemize):

4 Add lines 1, 2, and 3 . . . . . . .

5 Distributions: a Cash . . .b Stock . . .c Property . .


7 Add lines 5 and 6 . . . . .8 Balance at end of year (line 4 less line 7)

Form 1120-RIC (2010)

BALANCE SHEET CODE




Form 1120S Department of the Treasury Internal Revenue Service

U.S. Income Tax Return for an S Corporation Do not file this form unless the corporation has filed or is

attaching Form 2553 to elect to be an S corporation. See separate instructions.

OMB No. 1545-0130

2010For calendar year 2010 or tax year beginning , 2010, ending , 20

Use IRS label. Other- wise, print or type.

Name



A S election effective date

B Business activity code number (see instructions)

C Check if Sch. M-3 attached

D Emp yer identification number

E Date incorporated

F Total assets (see instructions)

$

G Is the corporation electing to be an S corporation beginning with this tax year Yes No If “Yes,” attach Form 2553 if not already filed H Check if: (1) Final return (2) Name change (3) Address change

(4) Amended return (5) S election termination or revocation I Enter the number of shareholders who were shareholders during any part of the tax year . . . . . . . . . Caution. Include only trade or business income and expenses on lines 1a through 21. See the instructions for more information.

Inco

me

1 a Gross receipts or sales b Less returns and allowances c Bal 1c 2 Cost of goods sold (Schedule A, line 8) . . . . . . . . . . . . . . . . . . 2 3 Gross profit. Subtract line 2 from line 1c . . . . . . . . . . . . . . . . . . 3 4 Net gain (loss) from Form 4797, Part II, line 17 (attach Form 4797) . . . . . . . . . . 4 5 Other income (loss) (see instructions—attach statement) . . . . . . . . . . . . . 5 6 Total income (loss). Add lines 3 through 5 . . . . . . . . . . . . . . . 6

Ded

ucti

ons

(se

e in

stru

ctio

ns fo

r lim

itatio

ns) 7 Compensation of officers . . . . . . . . . . . . . . . . . . . . . . . 7

8 Salaries and wages (less employment credits) . . . . . . . . . . . . . . . . 8 9 Repairs and maintenance . . . . . . . . . . . . . . . . . . . . . . . 9

10 Bad debts . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 11 Rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Taxes and licenses . . . . . . . . . . . . . . . . . . . . . . . . . 12 13 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Depreciation not claimed on Schedule A or elsewhere on return (attach Form 4562) . . . . . 14 15 Depletion (Do not deduct oil and gas depletion.) . . . . . . . . . . . . . . . 15 16 Advertising . . . . . . . . . . . . . . . . . . . . . . . . . . 16 17 Pension, profit-sharing, etc., plans . . . . . . . . . . . . . . . . . . . . 17 18 Employee benefit programs . . . . . . . . . . . . . . . . . . . . . . 18 19 Other deductions (attach statement . . . . . . . . . . . . . . . . . . 19 20 Total deductions. Add lines 7 through 19 . . . . . . . . . . . . . . . . 20 21 Ordinary business income (loss). Subtract line 20 from line 6 . . . . . . . . . . . 21

Tax

and

Pay

men

ts

22 a Excess net passive income or LIFO recapture tax (see instructions) . . 22a b Tax from Schedule D (Form 1120S) . . . . . . . . . . 22b c Add lines 22a and 22b (see instructions for additional taxes) . . . . . . . . . . . . 22c

23a 2010 estimated tax payments and 2009 overpayment credited to 2010 23a b Tax deposited with Form 7004 . . . . . . . . . . . . 23b c Credit for federal tax paid on fuels (attach Form 4136) . . . . . 23c d Add lines 23a through 23c . . . . . . . . . . . . . . . . . . . . . 23d

24 Estimated tax penalty (see instructions). Check if Form 2220 is attached . . . . . . 24 25 Amount owed. If line 23d is smaller than the total of lines 22c and 24, enter amount owed . . 25 26 Overpayment. If line 23d is larger than the total of lines 22c and 24, enter amount overpaid . . 26 27 Enter amount from line 26 Credited to 2011 estimated tax Refunded 27

Sign Here



May the IRS discuss this return

with the preparer shown below

(see instructions)? Yes No



PTIN



For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11510H Form 1120S (2010)

X

INCOME ADJUSTMENT

OVERPAYMENT

ADJUSTMENT TO TOTAL Recapture Tax From Form 4255


PAID PREPARER CODE

ESOP DIVIDENDS

TOTAL AMORTIZATION DEDUCTION ADJUSTMENT

STORED GENERAGED TOTAL RECEIPTS

ADJ TO TAX DUE

MERGE EIN PRIOR YEAR EIN


Form 1120S (2010) Page 2 Schedule A Cost of Goods Sold (see instructions)

1 Inventory at beginning of year . . . . . . . . . . . . . . . . . . . . . . 1 2 Purchases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Cost of labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Additional section 263A costs (attach statement) . . . . . . . . . . . . . . . . . 4 5 Other costs (attach statement) . . . . . . . . . . . . . . . . . . . . . . 5 6 Total. Add lines 1 through 5 . . . . . . . . . . . . . . . . . . . . . . . 6 7 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 7 8 Cost of goods sold. Subtract line 7 from line 6. Enter here and on page 1, line 2 . . . . . . . 8 9a Check all methods used for valuing closing inventory: (i) Cost as described in Regulations section 1.471-3

(ii) Lower of cost or market as described in Regulations section 1.471-4 (iii) Other (Specify method used and attach explanation.)

b Check if there was a writedown of subnormal goods as described in Regulations section 1.471-2(c) . . . . . . . . . c Check if the LIFO inventory method was adopted this tax year for any goods (if checked, attach Form 970) . . . . . . d If the LIFO inventory method was used for this tax year, enter percentage (or amounts) of closing

inventory computed under LIFO . . . . . . . . . . . . . . . . . . . . . . 9d e If property is produced or acquired for resale, do the rules of section 263A apply to the corporation? . . . Yes Nof Was there any change in determining quantities, cost, or valuations between opening and closing inventory? . . Yes No

If “Yes,” attach explanation. Schedule B Other Information (see instructions) Yes No

1 Check accounting method: a Cash b Accrual c Other (specify)

2 See the instructions and enter the: a Business activity b Product or service

3 At the end of the tax year, did the corporation own, directly or indirectly, 50% or more of the voting stock of a domestic corporation? (For rules of attribution, see section 267(c).) If “Yes,” attach a statement showing: (a) name and employer identification number (EIN), (b) percentage owned, and (c) if 100% owned, was a qualified subchapter S subsidiary election made? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 Has this corporation filed, or is it required to file, Form 8918, Material Advisor Disclosure Statement, to provide information on any reportable transaction? . . . . . . . . . . . . . . . . . . . . . . .

5 Check this box if the corporation issued publicly offered debt instruments with original issue discount . . . .

If checked, the corporation may have to file Form 8281, Information Return for Publicly Offered Original Issue Discount Instruments.

6 If the corporation: (a) was a C corporation before it elected to be an S corporation or the corporation acquired an

asset with a basis determined by reference to the basis of the asset (or the basis of any other property) in

the hands of a C corporation and (b) has net unrealized built-in gain in excess of the net recognized built-in gain

from prior years, enter the net unrealized built-in gain reduced by net recognized built-in gain from prior years (see

instructions) . . . . . . . . . . . . . . . $

7 Enter the accumulated earnings and profits of the corporation at the end of the tax year. $ 8 Are the corporation’s total receipts (see instructions) for the tax year and its total assets at the end of the tax year less

than $250,000? If “Yes,” the corporation is not required to complete Schedules L and M-1 . . . . . . . .

Schedule K Shareholders’ Pro Rata Share Items Total amount

Inco

me

(Lo

ss)

1 Ordinary business income (loss) (page 1, line 21) . . . . . . . . . . . . . . 1 2 Net rental real estate income (loss) (attach Form 8825) . . . . . . . . . . . . 2 3a Other gross rental income (loss) . . . . . . . . . . 3a

b Expenses from other rental activities (attach statement) . . . 3b c Other net rental income (loss). Subtract line 3b from line 3a . . . . . . . . . . 3c

4 Interest income . . . . . . . . . . . . . . . . . . . . . . . . 4 5 Dividends: a Ordinary dividends . . . . . . . . . . . . . . . . . . . 5a

b Qualified dividends . . . . . . . . . . 5b 6 Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . 6 7 Net short-term capital gain (loss) (attach Schedule D (Form 1120S)) . . . . . . . . 7 8 a Net long-term capital gain (loss) (attach Schedule D (Form 1120S)) . . . . . . . . 8a

b Collectibles (28%) gain (loss) . . . . . . . . . . . 8b c Unrecaptured section 1250 gain (attach statement) . . . . 8c

9 Net section 1231 gain (loss) (attach Form 4797) . . . . . . . . . . . . . . 9 10 Other income (loss) (see instructions) . . Type 10

Form 1120S (2010)

9 During the tax year, was a qualified subchapter S subsidiary election terminated or revoked? If "Yes," see instructions

COST OF GOODS BEGINNING INVENTORY ADJUSTMENTADJUSTMENT TO PURCHASES

AMOUNT

SOI INDUSTRY CODE

INCLUDES 16 ITEMS FROM OTHER COSTS. PLEASE REFER TO FORM 1120, PAGE 2 FOR A LISTING OF THE SPECIFIC ITEMS.

PERCENT


Form 1120S (2010) Page 3

Ded

ucti

ons

Shareholders’ Pro Rata Share Items (continued) Total amount

11 Section 179 deduction (attach Form 4562) . . . . . . . . . . . . . . . 11 12 a Contributions . . . . . . . . . . . . . . . . . . . . . . . . 12a

b Investment interest expense . . . . . . . . . . . . . . . . . . . 12b c Section 59(e)(2) expenditures (1) Type (2) Amount 12c(2) d Other deductions (see instructions) . . . Type 12d

Cre

dit

s

13a Low-income housing credit (section 42(j)(5)) . . . . . . . . . . . . . . . 13a b Low-income housing credit (other) . . . . . . . . . . . . . . . . . 13b c Qualified rehabilitation expenditures (rental real estate) (attach Form 3468) . . . . . 13c d Other rental real estate credits (see instructions) Type 13d e Other rental credits (see instructions) . . . Type 13e f Alcohol and cellulosic biofuel fuels credit (attach Form 6478) . . . . . . . . . 13f g Other credits (see instructions) . . . . . Type 13g

Fore

ign

Tra

nsac

tio

ns

14a Name of country or U.S. possession

b Gross income from all sources . . . . . . . . . . . . . . . . . . . 14b c Gross income sourced at shareholder level . . . . . . . . . . . . . . . 14c

Foreign gross income sourced at corporate level d Passive category . . . . . . . . . . . . . . . . . . . . . . . 14d e General category . . . . . . . . . . . . . . . . . . . . . . . 14e f Other (attach statement) . . . . . . . . . . . . . . . . . . . . . 14f

Deductions allocated and apportioned at shareholder level g Interest expense . . . . . . . . . . . . . . . . . . . . . . . 14g

h Other . . . . . . . . . . . . . . . . . . . . . . . . . . . 14h Deductions allocated and apportioned at corporate level to foreign source income

i Passive category . . . . . . . . . . . . . . . . . . . . . . . 14i j General category . . . . . . . . . . . . . . . . . . . . . . . 14j

k Other (attach statement) . . . . . . . . . . . . . . . . . . . . . 14k Other information

l Total foreign taxes (check one): Paid Accrued . . . . . . . . . 14l m Reduction in taxes available for credit (attach statement) . . . . . . . . . . . 14m n Other foreign tax information (attach statement)

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15 a Post-1986 depreciation adjustment . . . . . . . . . . . . . . . . . 15a b Adjusted gain or loss . . . . . . . . . . . . . . . . . . . . . . 15b c Depletion (other than oil and gas) . . . . . . . . . . . . . . . . . . 15c d Oil, gas, and geothermal properties—gross income . . . . . . . . . . . . 15d e Oil, gas, and geothermal properties—deductions . . . . . . . . . . . . . 15e f Other AMT items (attach statement) . . . . . . . . . . . . . . . . . 15f

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16 a Tax-exempt interest income . . . . . . . . . . . . . . . . . . . 16a b Other tax-exempt income . . . . . . . . . . . . . . . . . . . . 16b c Nondeductible expenses . . . . . . . . . . . . . . . . . . . . 16c d Distributions (attach statement if required) (see instructions) . . . . . . . . . . 16d e Repayment of loans from shareholders . . . . . . . . . . . . . . . . 16e

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b Investment expenses . . . . . . . . . . . . . . . . . . . . . . 17b c Dividend distributions paid from accumulated earnings and profits . . . . . . . 17c d Other items and amounts (attach statement)

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18 Income/loss reconciliation. Combine the amounts on lines 1 through 10 in the far right column. From the result, subtract the sum of the amounts on lines 11 through 12d and 14l 18

Form 1120S (2010)


Form 1120S (2010) Page 4 Schedule L Balance Sheets per Books Beginning of tax year End of tax year

( ) ( )

( ) ( )

( ) ( )

( ) ( )

( ) ( )


1 Cash . . . . . . . . . . . . .2a Trade notes and accounts receivable . . .b Less allowance for bad debts . . . . . .

3 Inventories . . . . . . . . . . .4 U.S. government obligations . . . . . .5 Tax-exempt securities (see instructions) . .6 Other current assets (attach statement) . . .7 Loans to shareholders . . . . . . . .8 Mortgage and real estate loans . . . . .9 Other investments (attach statement) . . .

10a Buildings and other depreciable assets . . .b Less accumulated depreciation . . . . .

11a Depletable assets . . . . . . . . .b Less accumulated depletion . . . . . .

12 Land (net of any amortization) . . . . . .13a Intangible assets (amortizable only) . . . .

b Less accumulated amortization . . . . .14 Other assets (attach statement) . . . . .15 Total assets . . . . . . . . . .

Liabilities and Shareholders’ Equity

16 Accounts payable . . . . . . . . .17 Mortgages, notes, bonds payable in less than 1 year 18 Other current liabilities (attach statement) . .19 Loans from shareholders . . . . . . .20 Mortgages, notes, bonds payable in 1 year or more 21 Other liabilities (attach statement) . . . .22 Capital stock . . . . . . . . . . .23 Additional paid-in capital . . . . . . .24 Retained earnings . . . . . . . . .25 Adjustments to shareholders’ equity (attach statement) 26 Less cost of treasury stock . . . . . .27 Total liabilities and shareholders’ equity . .

Schedule M-1 Reconciliation of Income (Loss) per Books With Income (Loss) per Return Note: Schedule M-3 required instead of Schedule M-1 if total assets are $10 million or more—see instructions


2 Income included on Schedule K, lines 1, 2, 3c, 4, 5a, 6, 7, 8a, 9, and 10, not recorded on books this year (itemize):

3 Expenses recorded on books this year not included on Schedule K, lines 1 through 12 and 14l (itemize):

a Depreciation $

b Travel and entertainment $

4 Add lines 1 through 3 . . . . . . . .

5 Income recorded on books this year not includedon Schedule K, lines 1 through 10 (itemize):


6 Deductions included on Schedule K, lines 1 through 12 and 14l, not charged against book income this year (itemize):

a Depreciation $

7 Add lines 5 and 6 . . . . .8 Income (loss) (Schedule K, line 18). Line 4 less line 7

Schedule M-2 Analysis of Accumulated Adjustments Account, Other Adjustments Account, and Shareholders’ Undistributed Taxable Income Previously Taxed (see instructions)

( )( ) ( )

(a) Accumulated adjustments account

(b) Other adjustments account

(c) Shareholders’ undistributed taxable income previously taxed

1 Balance at beginning of tax year . . . . .2 Ordinary income from page 1, line 21 . . .3 Other additions . . . . . . . . . .4 Loss from page 1, line 21 . . . . . . .5 Other reductions . . . . . . . . . .6 Combine lines 1 through 5 . . . . . . .7 Distributions other than dividend distributions 8 Balance at end of tax year. Subtract line 7 from line 6

Form 1120S (2010)

BALANCE SHEET ELIMINATION CODE



BALANCE SHEET CODE

TOTAL OF LINES 7a+7b+7c=S-GEN-TOT-DIST-M2


SCHEDULE D (Form 1120S)


Capital Gains and Losses and Built-in Gains

Attach to Form 1120S. See separate instructions.

OMB No. 1545-0130


Part I Short-Term Capital Gains and Losses—Assets Held One Year or Less (a) Description of property

(Example: 100 shares of Z Co.) (b) Date acquired

(mo., day, yr.) (c) Date sold (mo., day, yr.)

(d) Sales price (e) Cost or other basis

(see instructions)


1

2 Short-term capital gain from installment sales from Form 6252, line 26 or 37 . . . . . . . . 2 3 Short-term capital gain or (loss) from like-kind exchanges from Form 8824 . . . . . . . . 3 4 Combine lines 1 through 3 in column (f) . . . . . . . . . . . . . . . . . . . . 4 5 Tax on short-term capital gain included on line 21 below . . . . . . . . . . . . . . 5 ( )

6 Net short-term capital gain or (loss). Combine lines 4 and 5. Enter here and on Form 1120S, Schedule K, line 7 or 10 . . . . . . . . . . . . . . . . . . . . . . . . . 6

Part II Long-Term Capital Gains and Losses—Assets Held More Than One Year (a) Description of property

(Example: 100 shares of Z Co.) (b) Date acquired

(mo., day, yr.) (c) Date sold (mo., day, yr.)

(d) Sales price (e) Cost or other basis

(see instructions)


7

8 Long-term capital gain from installment sales from Form 6252, line 26 or 37 . . . . . . . . 8 9 Long-term capital gain or (loss) from like-kind exchanges from Form 8824 . . . . . . . . 9

10 Capital gain distributions . . . . . . . . . . . . . . . . . . . . . . . . . 10 11 Combine lines 7 through 10 in column (f) . . . . . . . . . . . . . . . . . . . 11 12 Tax on long-term capital gain included on line 21 below . . . . . . . . . . . . . . 12 ( )

13 Net long-term capital gain or (loss). Combine lines 11 and 12. Enter here and on Form 1120S, Schedule K, line 8a or 10 . . . . . . . . . . . . . . . . . . . . . . . . . 13

Part III Built-in Gains Tax (See instructions before completing this part.) 14 Excess of recognized built-in gains over recognized built-in losses (attach computation schedule) . 14 15 Taxable income (attach computation schedule) . . . . . . . . . . . . . . . . . 15 16 Net recognized built-in gain. Enter the smallest of line 14, line 15, or line 6 of Schedule B . . . 16 17 Section 1374(b)(2) deduction . . . . . . . . . . . . . . . . . . . . . . . 17 18 Subtract line 17 from line 16. If zero or less, enter -0- here and on line 21 . . . . . . . . . 18 19 Enter 35% of line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . 19 20 Section 1374(b)(3) business credit and minimum tax credit carryforwards from C corporation years 20 21 Tax. Subtract line 20 from line 19 (if zero or less, enter -0-). Enter here and on Form 1120S, page 1,

line 22b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 For Paperwork Reduction Act Notice, see the Instructions for Form 1120S. Cat. No. 11516V Schedule D (Form 1120S) 2010

TAX BASE CODE



Schedule K-1 (Form 1120S) Department of the Treasury Internal Revenue Service

2010For calendar year 2010, or tax


ending , 20

Shareholder’s Share of Income, Deductions, Credits, etc. See back of form and separate instructions.

Information About the Corporation Part I

A Corporation’s employer identification number

B Corporation’s name, address, city, state, and ZIP code

C IRS Center where corporation filed return

Information About the Shareholder Part II

D Shareholder’s identifying number

E Shareholder’s name, address, city, state, and ZIP code

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6 Royalties








12 Other deductions

13 Credits



16 Items affecting shareholder basis


For Paperwork Reduction Act Notice, see Instructions for Form 1120S. Cat. No. 11520D Schedule K-1 (Form 1120S) 2010

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Schedule K-1 (Form 1120S) 2010 Page 2 This list identifies the codes used on Schedule K-1 for all shareholders and provides summarized reporting information for shareholders who file Form 1040. For detailed reporting and filing information, see the separate Shareholder’s Instructions for Schedule K-1 and the instructions for your income tax return.

1. Ordinary business income (loss). Determine whether the income (loss) is passive or nonpassive and enter on your return as follows:

Report on Passive loss See the Shareholder’s Instructions Passive income Schedule E, line 28, column (g) Nonpassive loss Schedule E, line 28, column (h) Nonpassive income Schedule E, line 28, column (j)

2. Net rental real estate income (loss) See the Shareholder’s Instructions 3. Other net rental income (loss)

Net income Schedule E, line 28, column (g) Net loss See the Shareholder’s Instructions

4. Interest income Form 1040, line 8a 5a. Ordinary dividends Form 1040, line 9a 5b. Qualified dividends Form 1040, line 9b

6. Royalties Schedule E, line 4

7. Net short-term capital gain (loss) Schedule D, line 5, column (f)

8a. Net long-term capital gain (loss) Schedule D, line 12, column (f) 8b. Collectibles (28%) gain (loss) 28% Rate Gain Worksheet, line 4

(Schedule D instructions)

8c. Unrecaptured section 1250 gain See the Shareholder’s Instructions 9. Net section 1231 gain (loss) See the Shareholder’s Instructions

10. Other income (loss)

CodeA Other portfolio income (loss) See the Shareholder’s Instructions B Involuntary conversions See the Shareholder’s Instructions C Sec. 1256 contracts & straddles Form 6781, line 1 D Mining exploration costs recapture See Pub. 535 E Other income (loss) See the Shareholder’s Instructions

11. Section 179 deduction See the Shareholder’s Instructions

12. Other deductions A Cash contributions (50%)

} See the Shareholder’s Instructions

B Cash contributions (30%) C Noncash contributions (50%) D Noncash contributions (30%) E Capital gain property to a 50%

organization (30%) F Capital gain property (20%) G Contributions (100%) H Investment interest expense Form 4952, line 1 I Deductions—royalty income Schedule E, line 18 J Section 59(e)(2) expenditures See the Shareholder’s Instructions K Deductions—portfolio (2% floor) Schedule A, line 23 L Deductions—portfolio (other) Schedule A, line 28

M Preproductive period expenses See the Shareholder’s Instructions N Commercial revitalization deduction

from rental real estate activities See Form 8582 instructions O Reforestation expense deduction See the Shareholder’s Instructions P Domestic production activities

information See Form 8903 instructions Q Qualified production activities income Form 8903, line 7b R Employer’s Form W-2 wages Form 8903, line 17 S Other deductions See the Shareholder’s Instructions

13. Credits A Low-income housing credit (section

42(j)(5)) from pre-2008 buildings See the Shareholder’s Instructions B Low-income housing credit (other) from

pre-2008 buildings See the Shareholder’s Instructions C Low-income housing credit (section

42(j)(5)) from post-2007 buildings Form 8586, line 11 D Low-income housing credit (other)

from post-2007 buildings Form 8586, line 11 E Qualified rehabilitation

expenditures (rental real estate) } See the Shareholder’s Instructions F Other rental real estate credits

G Other rental credits H Undistributed capital gains credit Form 1040, line 71, box a I Alcohol and cellulosic biofuel fuels

credit Form 6478, line 8 J Work opportunity credit Form 5884, line 3 K Disabled access credit See the Shareholder’s Instructions L Empowerment zone and renewal

communtiy employment credit Form 8844, line 3

Code Report on M Credit for increasing research

activities See the Shareholder’s Instructions N Credit for employer social security

and Medicare taxes Form 8846, line 5 O Backup withholding Form 1040, line 61P Other credits See the Shareholder’s Instructions

14. Foreign transactions A Name of country or U.S.

possession } Form 1116, Part I B Gross income from all sources C Gross income sourced at

shareholder level Foreign gross income sourced at corporate level D Passive category } Form 1116, Part I E General category F Other Deductions allocated and apportioned at shareholder level G Interest expense Form 1116, Part I H Other Form 1116, Part I Deductions allocated and apportioned at corporate level to foreign sourceincomeI Passive category } Form 1116, Part I J General category

K Other Other information L Total foreign taxes paid Form 1116, Part II M Total foreign taxes accrued Form 1116, Part II N Reduction in taxes available for

credit Form 1116, line 12 O Foreign trading gross receipts Form 8873 P Extraterritorial income exclusion Form 8873 Q Other foreign transactions See the Shareholder’s Instructions

15. Alternative minimum tax (AMT) items A Post-1986 depreciation adjustment

} See the Shareholder’s Instructions and the Instructions for Form 6251

B Adjusted gain or loss C Depletion (other than oil & gas) D Oil, gas, & geothermal—gross income E Oil, gas, & geothermal—deductions F Other AMT items

16. Items affecting shareholder basis A Tax-exempt interest income Form 1040, line 8b B Other tax-exempt income


C Nondeductible expenses D Distributions E Repayment of loans from

shareholders

17. Other information A Investment income Form 4952, line 4a B Investment expenses Form 4952, line 5 C Qualified rehabilitation expenditures

(other than rental real estate) See the Shareholder’s Instructions D Basis of energy property See the Shareholder’s Instructions E Recapture of low-income housing

credit (section 42(j)(5)) Form 8611, line 8 F Recapture of low-income housing

credit (other) Form 8611, line 8 G Recapture of investment credit See Form 4255 H Recapture of other credits See the Shareholder’s Instructions I Look-back interest—completed

long-term contracts See Form 8697 J Look-back interest—income forecast

method See Form 8866 K Dispositions of property with

section 179 deductions


L Recapture of section 179 deduction

M Section 453(l)(3) information N Section 453A(c) information O Section 1260(b) information P Interest allocable to production

expenditures Q CCF nonqualified withdrawals R Depletion information—oil and gas S Amortization of reforestation

costs T Section 108(i) informationU Other information


SCHEDULE M-3 (Form 1120S)


Net Income (Loss) Reconciliation for S Corporations With Total Assets of $10 Million or More

Attach to Form 1120S. See separate instructions.

OMB No. 1545-0130



1a Did the corporation prepare a certified audited non-tax-basis income statement for the period ending with or within this tax year? (See instructions if multiple non-tax-basis income statements are prepared.)

Yes. Skip line 1b and complete lines 2 through 11 with respect to that income statement. No. Go to line 1b.

b Did the corporation prepare a non-tax-basis income statement for that period? Yes. Complete lines 2 through 11 with respect to that income statement. No. Skip lines 2 through 3b and enter the corporation’s net income (loss) per its books and records on line 4a.

2 Enter the income statement period: Beginning / / Ending / /

3 a Has the corporation’s income statement been restated for the income statement period on line 2? Yes. (If “Yes,” attach an explanation and the amount of each item restated.) No.

b Has the corporation’s income statement been restated for any of the five income statement periods preceding the period online 2?

Yes. (If “Yes,” attach an explanation and the amount of each item restated.) No.

4a Worldwide consolidated net income (loss) from income statement source identified in Part I, line 1 . 4a b Indicate accounting standard used for line 4a (see instructions):

(1) GAAP (2) IFRS (3) Tax-basis (4) Other (specify)

5a Net income from nonincludible foreign entities (attach schedule) . . . . . . . . . . . . . 5a ( )

b Net loss from nonincludible foreign entities (attach schedule and enter as a positive amount) . . . 5b

6 a Net income from nonincludible U.S. entities (attach schedule) . . . . . . . . . . . . . 6a ( )

b Net loss from nonincludible U.S. entities (attach schedule and enter as a positive amount) . . . . 6b

7a Net income (loss) of other foreign disregarded entities (attach schedule) . . . . . . . . . . 7a b Net income (loss) of other U.S. disregarded entities (except qualified subchapter S subsidiaries)

(attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7b c Net income (loss) of other qualified subchapter S subsidiaries (QSubs) (attach schedule) . . . . . 7c


9 Adjustment to reconcile income statement period to tax year (attach schedule) . . . . . . . . 9

10 Other adjustments to reconcile to amount on line 11 (attach schedule) . . . . . . . . . . . 10

11 Net income (loss) per income statement of the corporation. Combine lines 4 through 10 . . . 11 Note. Part I, line 11, must equal Part II, line 26, column (a).

12 Enter the total amount (not just the corporation’s share) of the assets and liabilities of all entities included or removed on the following lines:

Total Assets Total Liabilities a Included on Part I, line 4 b Removed on Part I, line 5 c Removed on Part I, line 6 d Included on Part I, line 7

For Paperwork Reduction Act Notice, see the Instructions for Form 1120S. Cat. No. 39666W Schedule M-3 (Form 1120S) 2010


Schedule M-3 (Form 1120S) 2010 Page 2 Name of corporation Employer identification number

Part II Reconciliation of Net Income (Loss) per Income Statement of the Corporation With Total Income (Loss) per Return (see instructions)

Income (Loss) Items (a)





Tax Return

1 Income (loss) from equity method foreign corporations (attach schedule) . . . . . . . .

2 Gross foreign dividends not previously taxed . . .3 Subpart F, QEF, and similar income inclusions (attach schedule) 4 Gross foreign distributions previously taxed (attach schedule) 5 Income (loss) from equity method U.S. corporations (attach schedule) 6 U.S. dividends not eliminated in tax consolidation .7 Income (loss) from U.S. partnerships (attach

schedule) . . . . . . . . . . . . . . .

8 Income (loss) from foreign partnerships (attach schedule) . . . . . . . . . . . . . . .

9 Income (loss) from other pass-through entities (attach schedule) . . . . . . . . . . . .

10 Items relating to reportable transactions (attach details) . . . . . . . . . . . . . . . .

11 Interest income (attach Form 8916-A) . . . . .12 Total accrual to cash adjustment . . . . . . .13 Hedging transactions . . . . . . . . . . .14 Mark-to-market income (loss) . . . . . . . .15 Cost of goods sold (attach Form 8916-A) . . . .16 Sale versus lease (for sellers and/or lessors) . . .17 Section 481(a) adjustments . . . . . . . . .18 Unearned/deferred revenue . . . . . . . . .19 Income recognition from long-term contracts . . .20 Original issue discount and other imputed interest .21a Income statement gain/loss on sale, exchange,

abandonment, worthlessness, or other disposition of assets other than inventory and pass-through entities


c Gross capital losses from Schedule D, excluding amounts from pass-through entities, abandonment losses, and worthless stock losses . . . . . .

d Net gain/loss reported on Form 4797, line 17, excluding amounts from pass-through entities, abandonment losses, and worthless stock losses .

e Abandonment losses . . . . . . . . . . .f Worthless stock losses (attach details) . . . . .g Other gain/loss on disposition of assets other than

inventory . . . . . . . . . . . . . . .

22 Other income (loss) items with differences (attach schedule) . . . . . . . . . . . . . . .

23 Total income (loss) items. Combine lines 1 through 22 . . . . . . . . . . . . . . . . .

24 Total expense/deduction items (from Part III, line 32) . . . . . . . . . . . . . . . . .

25 Other items with no differences . . . . . . .26 Reconciliation totals. Combine lines 23 through 25

( ) ( )

Note. Line 26, column (a), must equal the amount on Part I, line 11, and column (d) must equal Form 1120S, Schedule K, line 18.

Schedule M-3 (Form 1120S) 2010


Schedule M-3 (Form 1120S) 2010 Page 3 Name of corporation Employer identification number

Part III Reconciliation of Net Income (Loss) per Income Statement of the Corporation With Total Income (Loss) per Return—Expense/Deduction Items (see instructions)

Expense/Deduction Items (a)




(d) Deduction per

Tax Return

1 U.S. current income tax expense . . . . . . .2 U.S. deferred income tax expense . . . . . .3 State and local current income tax expense . . .4 State and local deferred income tax expense . . .5 Foreign current income tax expense (other than

foreign withholding taxes) . . . . . . . . .

6 Foreign deferred income tax expense . . . . .7 Equity-based compensation . . . . . . . .8 Meals and entertainment . . . . . . . . . .9 Fines and penalties . . . . . . . . . . .

10 Judgments, damages, awards, and similar costs . .11 Pension and profit-sharing . . . . . . . . .12 Other post-retirement benefits . . . . . . . .13 Deferred compensation . . . . . . . . . .14 Charitable contribution of cash and tangible

property . . . . . . . . . . . . . . .

15 Charitable contribution of intangible property . . .16 Current year acquisition or reorganization investment

banking fees . . . . . . . . . . . . . .

17 Current year acquisition or reorganization legal and accounting fees . . . . . . . . . . . . .

18 Current year acquisition/reorganization other costs .19 Amortization/impairment of goodwill . . . . . .20 Amortization of acquisition, reorganization, and

start-up costs . . . . . . . . . . . . .

21 Other amortization or impairment write-offs . . .22 Section 198 environmental remediation costs . . .23a Depletion—Oil & Gas . . . . . . . . . . .

b Depletion—Other than Oil & Gas . . . . . . .24 Depreciation . . . . . . . . . . . . . .25 Bad debt expense . . . . . . . . . . . .26 Interest expense (attach Form 8916-A) . . . . .27 Corporate owned life insurance premiums . . . .28 Purchase versus lease (for purchasers and/or

lessees) . . . . . . . . . . . . . . .

29 Research and development costs (attach schedule) .30 Section 118 exclusion (attach schedule) . . . . .31 Other expense/deduction items with differences

(attach schedule) . . . . . . . . . . . .32 Total expense/deduction items. Combine lines 1

through 31. Enter here and on Part II, line 24, reporting positive amounts as negative and negative amounts as positive . . . . . . . . . . .

Schedule M-3 (Form 1120S) 2010


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4. In

tere

st5.

Gro

ss R

ents

, R

oyal

ties,

and

Li

cens

e Fe

es

6. G

ross

Inco

me

From

Per

form

ance

of

Ser

vice

s

7. O

ther

(att

ach

sch

edul

e)8.

Tot

al (a

dd

col

umns

2(

a) t

hrou

gh 7

)

A B C D E F To

tals

(ad

d li

nes

A t

hrou

gh F

)

* Fo

r se

ctio

n 86

3(b

) inc

ome,

NO

Ls, i

ncom

e fr

om R

ICs,

and

hig

h-ta

xed

inco

me,

use

a s

ingl

e lin

e (s

ee in

stru

ctio

ns).

Ded

ucti

ons

(IN

CLU

DE

Fo

reig

n B

ranc

h D

educ

tio

ns h

ere

and

on

Sch

edul

e F)

9. D

efin

itel

y A

lloca

ble

Ded

ucti

ons

Ren

tal,

Roy

alty

, and

Lic

ensi

ng E

xpen

ses

(a) D

epre

ciat

ion,

D

eple

tion,

and

A

mor

tizat

ion

(b) O

ther

E

xpen

ses

(c) E

xpen

ses

Rel

ated

to

Gro

ss

Inco

me

From

P

erfo

rman

ce o

f S

ervi

ces

(d) O

ther

D

efin

itely

A

lloca

ble

D

educ

tions

(e) T

otal

Def

inite

ly

Allo

cab

le

Ded

uctio

ns (a

dd

co

lum

ns 9

(a)

thro

ugh

9(d

))

10. A

pp

ortio

ned

Sha

re

of D

educ

tions

Not

D

efin

itely

Allo

cab

le

(ent

er a

mou

nt fr

om

app

licab

le li

ne o

f S

ched

ule

H, P

art

II,

colu

mn

(d))

11. N

et O

per

atin

g Lo

ss D

educ

tion

12. T

otal

D

educ

tions

(ad

d

colu

mns

9(e

) th

roug

h 11

)

13. T

otal

Inco

me

or

(Los

s) B

efor

e A

dju

stm

ents

(sub

trac

t co

lum

n 12

from

co

lum

n 8)

A B C D E FTo

tals

For

Pap

erw

ork

Red

ucti

on

Act

No

tice

, see

sep

arat

e in

stru

ctio

ns.

Cat

. No.

109

00F

Form

111

8 (R

ev. 1

2-20

09)


Form

111

8 (R

ev. 1

2-20

09)

Pag

e 2

Sch

edul

e B

Fore

ign

Tax

Cre

dit

(Rep

ort

all f

orei

gn t

ax a

mou

nts

in U

.S. d

olla

rs.)

Par

t I—

Fore

ign

Tax

es P

aid

, Acc

rued

, and

Dee

med

Pai

d (s

ee in

stru

ctio

ns)

1. C

red

it is

Cla

imed

fo

r Ta

xes:

Pai

dA

ccru

ed

Dat

e P

aid

Dat

e A

ccru

ed

2. F

orei

gn T

axes

Pai

d o

r A

ccru

ed (a

ttac

h sc

hed

ule

show

ing

amou

nts

in fo

reig

n cu

rren

cy a

nd c

onve

rsio

n ra

te(s

) use

d)

Tax

With

held

at

Sou

rce

on:

(a) D

ivid

end

s(b

) Int

eres

t(c

) Ren

ts, R

oyal

ties,

an

d L

icen

se F

ees

Oth

er F

orei

gn T

axes

Pai

d o

r A

ccru

ed o

n:

(d) S

ectio

n 86

3(b

) Inc

ome

(e) F

orei

gn

Bra

nch

Inco

me

(f) S

ervi

ces

Inco

me

(g) O

ther

(h) T

otal

For

eign

Tax

es

Paid

or A

ccru

ed (a

dd

colu

mns

2(a

) thr

ough

2(g

))

3. T

ax D

eem

ed P

aid

(fr

om S

ched

ule

C—

P

art

I, co

lum

n 10

, P

art

II, c

olum

n 8(

b),

and

Par

t III

, col

umn

8)

A B C D E FT

ota

ls (a

dd

line

s A

thr

ough

F)

Par

t II—

Sep

arat

e Fo

reig

n T

ax C

red

it (C

omp

lete

a s

epar

ate

Par

t II

for

each

ap

plic

able

cat

egor

y of

inco

me.

)1

Tota

l for

eign

tax

es p

aid

or

accr

ued

(tot

al fr

om P

art

I, co

lum

n 2(

h))

..

..

..

..

..

..

..

..

..

..

..

.2

Tota

l tax

es d

eem

ed p

aid

(tot

al fr

om P

art

I, co

lum

n 3)

.

..

..

..

..

..

..

..

..

..

..

..

..

..

3R

educ

tions

of t

axes

pai

d, a

ccru

ed, o

r d

eem

ed p

aid

(ent

er t

otal

from

Sch

edul

e G

) .

..

..

..

..

..

..

..

..

.(

)4

Taxe

s re

clas

sifie

d u

nder

hig

h-ta

x ki

ckou

t .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

5E

nter

the

sum

of a

ny c

arry

over

of f

orei

gn t

axes

(fro

m S

ched

ule

K, l

ine

3, c

olum

n (x

iv))

plu

s an

y ca

rryb

acks

to

the

curr

ent

tax

year

.

.6

Tota

l for

eign

tax

es (c

omb

ine

lines

1 t

hrou

gh 5

) .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

7E

nter

the

am

ount

fro

m t

he a

pp

licab

le c

olum

n of

Sch

edul

e J,

Par

t I,

line

11 (

see

inst

ruct

ions

). If

Sch

edul

e J

is n

ot

req

uire

d t

o b

e co

mp

lete

d,

ente

r th

e re

sult

from

the

“To

tals

” lin

e of

col

umn

13 o

f the

ap

plic

able

Sch

edul

e A

.

..

..

..

..

..

..

..

..

..

..

..

..

..

8aTo

tal t

axab

le in

com

e fr

om a

ll so

urce

s (e

nter

tax

able

inco

me

from

the

cor

por

atio

n’s

tax

retu

rn)

..

..

..

..

..

..

..

bA

dju

stm

ents

to

line

8a (s

ee in

stru

ctio

ns)

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

cS

ubtr

act

line

8b fr

om li

ne 8

a .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

9D

ivid

e lin

e 7

by

line

8c. E

nter

the

res

ultin

g fr

actio

n as

a d

ecim

al (s

ee in

stru

ctio

ns).

If lin

e 7

is g

reat

er t

han

line

8c, e

nter

1

..

..

..

..

..

.10

Tota

l U.S

. inc

ome

tax

agai

nst

whi

ch c

red

it is

allo

wed

(reg

ular

tax

liab

ility

(see

sec

tion

26(b

)) m

inus

Am

eric

an S

amoa

eco

nom

ic d

evel

opm

ent

cred

it)

..

11C

red

it lim

itatio

n (m

ultip

ly li

ne 9

by

line

10) (

see

inst

ruct

ions

) .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

12S

epar

ate

fore

ign

tax

cred

it (e

nter

the

sm

alle

r of

line

6 o

r lin

e 11

her

e an

d o

n th

e ap

pro

pria

te li

ne o

f Par

t III

) .

..

..

..

..

..

..

..

Par

t III

—S

umm

ary

of

Sep

arat

e C

red

its

(Ent

er a

mou

nts

from

Par

t II,

line

12

for

each

ap

plic

able

cat

egor

y of

inco

me.

Do

no

t in

clud

e ta

xes

pai

d t

o sa

nctio

ned c

ount

ries.

)1

Cre

dit

for

taxe

s on

pas

sive

cat

egor

y in

com

e .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.2

Cre

dit

for

taxe

s on

gen

eral

cat

egor

y in

com

e .

..

..

..

..

..

..

..

..

..

..

..

..

..

..

.3

Cre

dit

for

taxe

s on

inco

me

re-s

ourc

ed b

y tr

eaty

(com

bin

e al

l suc

h cr

edits

on

this

line

) .

..

..

..

..

..

..

..

.4

Tota

l (ad

d li

nes

1 th

roug

h 3)

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

..

5R

educ

tion

in c

red

it fo

r in

tern

atio

nal b

oyco

tt o

per

atio

ns (s

ee in

stru

ctio

ns)

..

..

..

..

..

..

..

..

..

..

..

..

..

.6

To

tal f

ore

ign

tax

cred

it (s

ubtr

act

line

5 fr

om li

ne 4

). E

nter

her

e an

d o

n th

e ap

pro

pria

te li

ne o

f the

cor

por

atio

n’s

tax

retu

rn

..

..

..

..

..

Form

111

8 (R

ev. 1

2-20

09)


Form

111

8 (R

ev. 1

2-20

09)

Pag

e 6

Sch

edul

e F

Gro

ss In

com

e an

d D

efin

itel

y A

lloca

ble

Ded

ucti

ons

fo

r Fo

reig

n B

ranc

hes

1. F

orei

gn C

ount

ry o

r U

.S. P

osse

ssio

n (E

nter

tw

o-le

tter

cod

e fr

om S

ched

ule

A, c

olum

n 1.

U

se a

sep

arat

e lin

e fo

r ea

ch.)

2. G

ross

Inco

me

3. D

efin

itely

Allo

cab

le

Ded

uctio

ns

A B C D E F

To

tals

(ad

d li

nes

A t

hrou

gh F

)* �

* N

ote

: Th

e S

ched

ule

F to

tals

are

not

car

ried

over

to a

ny o

ther

For

m 1

118

Sch

edul

e. (T

hese

tota

ls w

ere

alre

ady

incl

uded

in

Sch

edul

e A

.) H

owev

er, t

he IR

S r

equi

res

the

corp

orat

ion

to c

ompl

ete

Sch

edul

e F

unde

r th

e au

thor

ity o

f sec

tion

905(

b).

Sch

edul

e G

Red

ucti

ons

of

Tax

es P

aid

, Acc

rued

, or

Dee

med

Pai

d

AR

educ

tion

of

Taxe

s U

nder

S

ectio

n 90

1(e)

—A

ttac

h se

par

ate

sche

dul

e

BR

educ

tion

of

Fore

ign

Oil

and

G

as

Taxe

s—E

nter

am

ount

from

Sch

edul

e I,

Par

t II,

line

6

CR

educ

tion

of T

axes

Due

to In

tern

atio

nal B

oyco

tt Pr

ovis

ions

—

Ente

r app

ropr

iate

por

tion

of S

ched

ule

C (F

orm

571

3), l

ine

2b.

Impo

rtan

t: En

ter o

nly

“spe

cific

ally

attr

ibut

able

taxe

s” h

ere.

DR

educ

tion

of

Taxe

s fo

r S

ectio

n 60

38(c

) P

enal

ty—

A

ttac

h se

par

ate

sche

dul

e

EO

ther

Red

uctio

ns o

f Tax

es—

Att

ach

sche

dul

e(s)

To

tal

(ad

d l

ines

A t

hrou

gh E

). E

nter

her

e an

d o

n S

ched

ule

B, P

art

II, li

ne 3

.

..

..

..

..

..

..

. �

Form

111

8 (R

ev. 1

2-20

09)



Investment Credit

Attach to your tax return. See instructions.

OMB No. 1545-0155




1 Name of lessor2 Address of lessor3 Description of property4 Amount for which you were treated as having acquired the property . . . . . . . . . . $













a Check this box if you are electing under section 47(d)(5) to take your qualified rehabilitation expenditures into account for the tax year in which paid (or, for self-rehabilitated property, when capitalized). See instructions. Note. This election applies to the current tax year and to all later tax years. You may not revoke this election without IRS consent . . . . . . . . . . .





For Paperwork Reduction Act Notice, see instructions. Cat. No. 12276E











. . . . . . . . . . . . . . . . . . . . . $ × 10% (.10) 12a


. . . . . . . . . . . . . . . . . . . . . $ × 30% (.30) 12b



. . . . . . . . . . . . . . . . . . . . . $ × 30% (.30) 12c

d Applicable kilowatt capacity of property on line 12c (see instructions) × $1,000 12d



g Applicable kilowatt capacity of property on line 12f (see instructions) × $3,000 12g



j Kilowatt capacity of property on line 12i . . . . . . . . . . × $200 12j










. . . . . . . . . . . . . . . . . . . . . $ × 30% (.30) 12o













20 Add lines 16 through 19. Report this amount on Form 3800, line 29a . . . . . . . . . . 20



General Business Credit See separate instructions. Attach to your tax return.

OMB No. 1545-0895








claiming this credit from a pass-through entity: ) . . . . . 1k l Biodiesel and renewable diesel fuels credit . . . . . . . . . . . . . . . . . 1l m Low sulfur diesel fuel production credit (Form 8896) . . . . . . . . . . . . . . 1m n Distilled spirits credit (Form 8906) . . . . . . . . . . . . . . . . . . . . 1n o Nonconventional source fuel credit (Form 8907) . . . . . . . . . . . . . . . 1o p Energy efficient home credit . . . . . . . . . . . . . . . . . . . . . . 1p q Energy efficient appliance credit (Form 8909) . . . . . . . . . . . . . . . . 1q r Alternative motor vehicle credit (Form 8910) (enter EIN if claiming this credit from a











Form 3800 (2010) Page 2

Part II Allowable Credit

9 Regular tax before credits: • Individuals. Enter the amount from Form 1040, line 44 or Form 1040NR, line 42 .• Corporations. Enter the amount from Form 1120, Schedule J, line 2; or the

applicable line of your return . . . . . . . . . . . . . . . . . .• Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G,

lines 1a and 1b, or the amount from the applicable line of your return . . . .

} . . 9

10 Alternative minimum tax: • Individuals. Enter the amount from Form 6251, line 35 . . . . . . . .• Corporations. Enter the amount from Form 4626, line 14 . . . . . . . .• Estates and trusts. Enter the amount from Schedule I (Form 1041), line 56 . . } . . . 10

11 Add lines 9 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . 11

12 a Foreign tax credit . . . . . . . . . . . . . . . . 12a b Personal credits from Form 1040 or 1040NR (see instructions) . 12b c Add lines 12a and 12b . . . . . . . . . . . . . . . . . . . . . . . . 12c

13 Net income tax. Subtract line 12c from line 11. If zero, skip lines 14 through 17 and enter -0- on line 18a 13

14 Net regular tax. Subtract line 12c from line 9. If zero or less, enter -0- 14

15 Enter 25% (.25) of the excess, if any, of line 14 over $25,000 (see instructions) . . . . . . . . . . . . . . . . . . 15

16 Tentative minimum tax. If line 8 is zero and line 24 would be zero, skip lines 16 through 25 and go to line 26. Otherwise, see instructions . . . . . . . . . . . . . . . . . . 16


18a Subtract line 17 from line 13. If zero or less, enter -0- . . . . . . . . . . . . . . 18a b For a corporation electing to accelerate the research credit, enter the bonus depreciation

amount attributable to the research credit. (see instructions) . . . . . . . . . . . . 18b c Add lines 18a and 18b . . . . . . . . . . . . . . . . . . . . . . . . 18c

19a Enter the smaller of line 8 or line 18c . . . . . . . . . . . . . . . . . . . 19a C corporations: See the line 19a instructions if there has been an ownership change, acquisition, or reorganization.

b Enter the smaller of line 8 or line 18a. If you made an entry on line 18b, go to line 19c; otherwise, skip line 19c (see instructions) . . . . . . . . . . . . . . . . . . . . . . 19b

c Subtract line 19b from line 19a. This is the refundable amount for a corporation electing to accelerate the research credit. Include this amount on line 32g of Form 1120 (or the applicable line of your return) . . . . . . . . . . . . . . . . . . . . . . . . . . 19c

Form 3800 (2010)


Form 3800 (2010) Page 3

Part II Allowable Credit (Continued)

Note. If you are not filing Form 8844, skip lines 20 through 24 and enter -0- on line 25. 20 Multiply line 16 by 75% (see instructions) . . . . . . . . . . . . . . . . . . 20



23 Subtract line 19b from line 22. If zero or less, enter -0- . . . . . . . . . . . . . . 23

24 Enter the amount from Form 8844, line 10 or line 12, excluding any portion of the credit that is an eligible small business credit (see instructions) . . . . . . . . . . . . . . . 24

25 Empowerment zone and renewal community employment credit allowed. Enter the smaller of line 23 or line 24 . . . . . . . . . . . . . . . . . . . . . . . . . . 25


27 If you skipped lines 16 through 25, enter -0-. Otherwise, add lines 19b and 25 . . . . . . 27


29a Enter the investment credit from Form 3468, Part III, line 20 (attach Form 3468) . . . . . . . . . . . . . . . . . . 29a

b Enter the work opportunity credit from Form 5884, line 10 or line 12 . . . . . . . . . . . . . . . . . . . . 29b

c Enter the alcohol and cellulosic biofuel fuels credit from Form 6478, line 15 or line 17 . . . . . . . . . . . . . . . . . 29c

d Enter the low-income housing credit from Form 8586, Part II, line 18 or line 20 . . . . . . . . . . . . . . . . . . . 29d

e Enter the applicable part of the amount of the renewable electricity, refined coal, and Indian coal production credit from Form 8835, Part II, line 36 or line 38 . . . . . . . . . . . . . . 29e

f Enter the credit for employer social security and Medicare taxes paid on certain employee tips from Form 8846, line 12 . . . . 29f

g Enter the qualified railroad track maintenance credit from Form 8900, line 12 . . . . . . . . . . . . . . . . . . 29g

h Enter the credit for small employer health insurance premiums fromForm 8941, line 21 or line 23 (tax-exempt entities, other than farmers' cooperatives, do not complete this line—see instructions) (enter EIN if claiming this credit from a pass-through entity:

) . . . . . . . . . . . . . 29h

30 Add lines 29a through 29h and increase that sum by any eligible small business credits and enter the result (see instructions) . . . . . . . . . . . . . . . . . . . . . 30

31 Enter the smaller of line 28 or line 30 . . . . . . . . . . . . . . . . . . . 31

32 Credit allowed for the current year. Add lines 27 and 31. Report the amount from line 32 (if smaller than the sum of lines 8, 24, and 30, see instructions) as indicated below or on the applicable line of your return:

• Individuals. Form 1040, line 53 or Form 1040NR, line 50 . . . . . . .• Corporations. Form 1120, Schedule J, line 5c . . . . . . . . . .• Estates and trusts. Form 1041, Schedule G, line 2b . . . . . . . .

} . . . 32

Form 3800 (2010)




See separate instructions. Attach to your tax return.

OMB No. 1545-0172







10 Carryover of disallowed deduction from line 13 of your 2009 Form 4562 . . . . . . . . . . . 1011 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 1112 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 . . . . . 1213 Carryover of disallowed deduction to 2011. Add lines 9 and 10, less line 12 13

Note: Do not use Part II or Part III below for listed property. Instead, use Part V.Part II Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions.)14 Special depreciation allowance for qualified property (other than listed property) placed in service



asset accounts, check here . . . . . . . . . . . . . . . . . . . Section B—Assets Placed in Service During 2010 Tax Year Using the General Depreciation System

(a) Classification of property

(b) Month and year placed in

service



(d) Recovery period


19a 3-year propertyb 5-year propertyc 7-year propertyd 10-year propertye 15-year propertyf 20-year property

g 25-year propertyh Residential rental







25 yrs. S/L27.5 yrs. MM S/L27.5 yrs. MM S/L

39 yrs. MM S/LMM S/L

S/L12 yrs. S/L40 yrs. MM S/L

Y-EPZONE-CD

CLEAR DESCRIPTION CODE

50-YEARPROPERTY

BASISAMOUNT

50-YEARPROPERTYDEDUCTION






vehicles first)

(b) Date placed

in service

(c) Business/




use only)

(f) Recovery

period

(g) Method/

Convention

(h) Depreciation

deduction


cost







(a) Vehicle 1

(b) Vehicle 2

(c) Vehicle 3

(d) Vehicle 4

(e) Vehicle 5

(f) Vehicle 6


driven . . . . . . . . . . . .














begins


(d) Code section

(e) Amortization





Form 4562 (2010)

AMOUNTS FROM LINE 42(f) FOR: 195-BUSINESS START-UP EXPENDITURES 197-CERTAIN INTANG LES 169-POLLUTION CONTROL FACILITIES 178-COST OF ACQUIRING A LEASE99-CODE SECTION NOT REPORTED 9(e)- OPTIONAL WRIT OFF OF CERTAIN TAX PREFERENCES 194-QUALIF REFORESTATION AND REFORESTATION COSTS48-ORGANIZATIONAL EXPENDITURE FOR CORPORATIONS 174-RESEARCH AND EXPERIMENTA XPENDITURES 67H-GEOLOGICAL AND GEOPHYSICAL EXPENDITURES

171-CERTAIN BOND PREMIUMS 09 ORGANIZATIONAL EXPENDITURES FOR A PARTNERSHIP 1400L-QUALIFIED REVITALIZATION EXPENDITURES



Alternative Minimum Tax—Corporations See separate instructions.

Attach to the corporation’s tax return.

OMB No. 1545-0175


Note: See the instructions to find out if the corporation is a small corporation exempt from the alternative minimum tax (AMT) under section 55(e).

1 Taxable income or (loss) before net operating loss deduction . . . . . . . . . . . . . . 1

2 Adjustments and preferences:a Depreciation of post-1986 property . . . . . . . . . . . . . . . . . . . . . . 2a b Amortization of certified pollution control facilities. . . . . . . . . . . . . . . . . . 2bc Amortization of mining exploration and development costs . . . . . . . . . . . . . . 2c d Amortization of circulation expenditures (personal holding companies only) . . . . . . . . . 2de Adjusted gain or loss . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e f Long-term contracts . . . . . . . . . . . . . . . . . . . . . . . . . . . 2f

g Merchant marine capital construction funds. . . . . . . . . . . . . . . . . . . . 2gh Section 833(b) deduction (Blue Cross, Blue Shield, and similar type organizations only) . . . . . 2h i Tax shelter farm activities (personal service corporations only) . . . . . . . . . . . . . 2i j Passive activities (closely held corporations and personal service corporations only) . . . . . . 2j

k Loss limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2k l Depletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2l

m Tax-exempt interest income from specified private activity bonds . . . . . . . . . . . . 2mn Intangible drilling costs . . . . . . . . . . . . . . . . . . . . . . . . . . 2no Other adjustments and preferences . . . . . . . . . . . . . . . . . . . . . . 2o

3 Pre-adjustment alternative minimum taxable income (AMTI). Combine lines 1 through 2o . . . . . 3

4 Adjusted current earnings (ACE) adjustment:a ACE from line 10 of the ACE worksheet in the instructions . . . . . . . . 4a b Subtract line 3 from line 4a. If line 3 exceeds line 4a, enter the difference as a

negative amount (see instructions) . . . . . . . . . . . . . . . . 4bc Multiply line 4b by 75% (.75). Enter the result as a positive amount . . . . . 4c

d Enter the excess, if any, of the corporation’s total increases in AMTI from prior year ACE adjustments over its total reductions in AMTI from prior year ACE adjustments (see instructions). Note: You must enter an amount on line 4d (even if line 4b is positive) . . . . . . . . . . . . . . . . . . 4d

e ACE adjustment.• If line 4b is zero or more, enter the amount from line 4c . . .• If line 4b is less than zero, enter the smaller of line 4c or line 4d as a negative amount } 4e

5 Combine lines 3 and 4e. If zero or less, stop here; the corporation does not owe any AMT . . . . 5 6 Alternative tax net operating loss deduction (see instructions) . . . . . . . . . . . . . . 6

7 Alternative minimum taxable income. Subtract line 6 from line 5. If the corporation held a residual interest in a REMIC, see instructions . . . . . . . . . . . . . . . . . . . . . . 7

8 Exemption phase-out (if line 7 is $310,000 or more, skip lines 8a and 8b and enter -0- on line 8c):a Subtract $150,000 from line 7 (if completing this line for a member of a

controlled group, see instructions). If zero or less, enter -0- . . . . . . . 8a b Multiply line 8a by 25% (.25) . . . . . . . . . . . . . . . . . . 8bc Exemption. Subtract line 8b from $40,000 (if completing this line for a member of a controlled group,

see instructions). If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . 8c 9 Subtract line 8c from line 7. If zero or less, enter -0- . . . . . . . . . . . . . . . . . 9

10 Multiply line 9 by 20% (.20) . . . . . . . . . . . . . . . . . . . . . . . . . 10 11 Alternative minimum tax foreign tax credit (AMTFTC) (see instructions) . . . . . . . . . . . 11 12 Tentative minimum tax. Subtract line 11 from line 10 . . . . . . . . . . . . . . . . . 12 13 Regular tax liability before applying all credits except the foreign tax credit . . . . . . . 13 14 Alternative minimum tax. Subtract line 13 from line 12. If zero or less, enter -0-. Enter here and on

Form 1120, Schedule J, line 3, or the appropriate line of the corporation’s income tax return . . . 14For Paperwork Reduction Act Notice, see the instructions. Cat. No. 12955I Form 4626 (2010)

sec.38(c)(2)Adj.




Under Sections 179 and 280F(b)(2)) Attach to your tax return. See separate instructions.

OMB No. 1545-0184














sum of (d) and (e)




















4

PART II ADJUSTMENT



(see instructions)



A

B

C

D

These columns relate to the properties on lines 19A through 19D.Property A Property B Property C Property D




























(a) Section 179




Form 4797 (2010)

SECTION 1245PROPERTY

UNDETER- MINED PROPERTY

ALL OTHERPROPERTY


Information Return of a 25% Foreign-Owned U.S. Corporationor a Foreign Corporation Engaged in a U.S. Trade or Business

(Under Sections 6038A and 6038 of the ternal Revenu Code)

5472

Form

OMB No. 1545-0805



For tax year of the reporting corporation beginning , , and ending ,

Reporting Corporation (see instructions). All reporting corporations must complete Part I. Name of reporting corporation

1a


1b


1c

Total assets

City or town, state, and ZIP code (if a foreign address, see instructions)

Total number of Forms 5472filed for the tax year

1g

Total value of gross payments made or received(see instructions) reported on this Form 5472

1f

25% Foreign Shareholder (see instructions) 1a

Name and address of direct 25% foreign shareholder

1c

Principal country(ies) wherebusiness is conducted

1b

1d

Country of citizenship,organization, or incorporation

1e

Country(ies) under whose laws the direct 25% foreignshareholder files an income tax return as a resident

Related Party (see instructions)

Name and address of related party

1a

Principal country(ies) where business is conducted

1f

Country(ies) under whose laws the related party files an income tax return asa resident

1g

Part I

Part II

Part III

$


1b

Cat. No. 49987Y

Form 5472 (Rev. 12-2007)

2a

Name and address of direct 25% foreign shareholder

2c


2b

2d


2e

Country(ies) under whose laws the direct 25% foreignshareholder files an income tax return as a resident



For Paperwork Reduction Act Notice, see page 4.

1j

Country ofincorporation

1l


1k

Country(ies) under whose laws the reportingcorporation files an income tax return as a resident

3a

Name and address of ultimate indirect 25% foreign shareholder

3c

Principal country(ies) wherebusines s conducted

3b

3d


3e

Country(ies) under whose laws the ultimate indirect 25%foreign shareholder files an income tax return as a resident


4a

Name and address of ultimate indirect 25% foreign shareholder

4c


4b

4d


4e

Country(ies) under whose laws the ultimate indirect 25%foreign shareholder files an income tax return as a resident


Note. Enter all information in English and money items in U.S. dollars.

Check applicable box: Is the related party a

foreign person or

U.S. person? All reporting corporations must complete this question and the rest of Part III.

$

Principal business activity code �

1e

Principal business activity �

1d

Relationship—Check boxes that apply:

1e

Related to reporting corporation

Related to 25% foreign shareholder

25% foreign shareholder

Principal business activity code �

1d

Principal business activity �

1c

1i

Check here if thisis a consolidatedfiling of Form5472 �

Total value of gross payments made or received(see instructions) reported on all Forms 5472

1h

2

Check here if, at any time during the tax year, any foreign person owned, directly or indirectly, at least 50% of (a) the total votingpower of all classes of the stock of the reporting corporation entitled to vote, or (b) the total value of all classes of stock of thereporting corporation �

$


Page 2

Form 5472 (Rev. 12-2007)

Nonmonetary and Less-Than-Full Consideration Transactions Between the Reporting Corporationand the Foreign Related Party (see instructions)

Additional Information

Yes

No

1

Does the reporting corporation import goods from a foreign related party? Yes

No

If “Yes,” is the basis or inventory cost of the goods valued at greater than the customs value of the imported goods?If “No,” do not complete b and c below.

2a

b

If “Yes,” attach a statement explaining the reason or reasons for such difference. c

If the answers to questions 1 and 2a are “Yes,” were the documents used to support this treatment of the importedgoods in existence and available in the United States at the time of filing Form 5472?

Yes

No

Part VI

Part V

General Instructions Section references are to the InternalRevenue Code unless otherwise noted.

Monetary Transactions Between Reporting Corporations and Foreign Related Party (see instructions)Caution: Part IV must be completed if the “foreign person” box is checked in the heading for Part III. If estimates are used, check here �

1

Sales of stock in trade (inventory)

1 2

Sales of tangible property other than stock in trade

2 3a

Rents received (for other than intangible property rights)

3a

4

Sales, leases, licenses, etc., of intangible property rights (e.g., patents, trademarks, secret formulas)

4 5

Consideration received for technical, managerial, engineering, construction, scientific, or like services

5 6

Commissions received

6 7b

b Ending balance or monthly average �

a Beginning balance

Amounts borrowed (see instructions)

7 8

Interest received

8 9

Premiums received for insurance or reinsurance

9 10

Other amounts received (see instructions)

10 Total. Combine amounts on lines 1 through 10

11

11 12

Purchases of stock in trade (inventory)

12 13

Purchases of tangible property other than stock in trade

13 14a

Rents paid (for other than intangible property rights)

14a

15

Purchases, leases, licenses, etc., of intangible property rights (e.g., patents, trademarks, secret formulas)

15 16

Consideration paid for technical, managerial, engineering, construction, scientific, or like services

16 17

Commissions paid

17 18b

b Ending balance or monthly average �

a Beginning balance Amounts loaned (see instructions)

18 19

Interest paid

19 20

Premiums paid for insurance or reinsurance

20 21

Other amounts paid (see instructions)

21 Total. Combine amounts on lines 12 through 21

22

22

Part IV

Purpose of Form

Describe these transactions on an attached separate sheet and check here. �

All reporting corporations must complete Part VI.

Use Form 5472 to provide information requiredunder sections 6038A and 6038C whenreportable transactions occur during the tax yearof a reporting corporation with a foreign ordomestic related party.

Reporting corporation. A reporting corporationis either: ● A 25% foreign-owned U.S. corporation or

● A foreign corporation engaged in a trade orbusiness within the United States. 25% foreign owned. A corporation is 25%foreign owned if it has at least one direct orindirect 25% foreign shareholder at any timeduring the tax year. 25% foreign shareholder. Generally, aforeign person (defined on page 3) is a 25%foreign shareholder if the person owns,directly or indirectly, at least 25% of either: ● The total voting power of all classes ofstock entitled to vote or

● The total value of all classes of stock of thecorporation.

Definitions

● Any other person who is related to thereporting corporation within the meaning ofsection 482 and the related regulations.

● Any person who is related (within themeaning of section 267(b) or 707(b)(1)) to a25% foreign shareholder of the reportingcorporation, or

Related party. A related party is: ● Any direct or indirect 25% foreign

shareholder of the reporting corporation, ● Any person who is related (within themeaning of section 267(b) or 707(b)(1)) to thereporting corporation,

“Related party” does not include anycorporation filing a consolidated Federalincome tax return with the reportingcorporation.

What’s New ● The IRS has modified Part IV, lines 3 and14.

Royalties received (for other than intangible property rights)

b

3b

b

Royalties paid (for other than intangible property rights)

14b

● A reporting corporation that uses an accrualmethod of accounting must use accruedpayments and accrued receipts for purposes ofcomputing the total amount to enter on each lineof the Form 5472. See Regulations section1.6038A-2(b)(8).

318(a)(3)(A), (B), and (C) so as to consider aU.S. person as owning stock that is ownedby a foreign person.

The rules in section 318 apply to thedefinition of related party with themodifications listed under the definition of25% foreign shareholder above.

The constructive ownership rules of section318 apply with the following modifications todetermine if a corporation is 25% foreignowned. Substitute “10%” for “50%” insection 318(a)(2)(C). Do not apply sections


Version A, Cycle 5



New Hire Retention Credit Attach to your tax return.

Use Part II to list additional retained workers.

OMB No. 1545-XXXX

Attachment Sequence No. 77B







(c)





4 Multiply line 3 by 80% (.80) . . . . . . . . . 45 Enter the retained worker's wages for the second 26


6 Add lines 3 and 5 . . . . . . . . . . . . 6

7 Multiply line 6 by 6.2% (.062) . . . . . . . . 7

8 Maximum credit allowable . . . . . . . . . 8 1,000 00 1,000 00 1,000 00





13 Current year credit. Add lines 10 and 12. Partnerships and S corporations, report this amount onSchedule K; all others, report this amount on the applicable line of Form 3800 (e.g., line 1aa of the2010 Form 3800) . . . . . . . . . . . . . . . . . . . . . . . . . . . 13



Version A, Cycle 5

Form 5884-B (12-2010) Attachment Sequence No. 77B Page 2Name(s) shown on return. Do not enter name and identifying number if shown on other side. Identifying number

Part II Continuation Sheet for Additional Retained WorkersUse a separate column for each retained worker. Keep track of the number of workers listed by entering a number at the top of each column. For example, the first retained worker listed on the first attached Part II would be Retained Worker No. 4. If you need more columns, use additional copies of Part II. Include the totals from columns (a) through (c) of all lines 9 from all copies of Part II on Part I, line 10.

(a) Retained Worker

No.

(b) Retained Worker

No.

(c) Retained Worker

No.1 Enter the retained worker's social security number . 12 Enter the first date of employment from the retained

worker's Form W-11 or similar statement 2 / / 2010 / / 2010 / / 20103 Enter the retained worker's wages for the first 26

consecutive weeks of employment . . . . . . 34 Multiply line 3 by 80% (.80) . . . . . . . . . 4

5 Enter the retained worker's wages for the second 26 consecutive weeks of employment. If line 4 is larger than this amount, the qualified employee is not a retained worker and should not be listed on this form 5

6 Add lines 3 and 5 . . . . . . . . . . . . 67 Multiply line 6 by 6.2% (.062) . . . . . . . . 78 Maximum credit allowable . . . . . . . . . 8 1,000 00 1,000 00 1,000 009 Enter the smaller of line 7 or line 8 . . . . . . 9

(a) Retained Worker

No.

(b) Retained Worker

No.

(c) Retained Worker

No.1 Enter the retained worker's social security number 12 Enter the first date of employment from the retained


consecutive weeks of employment . . . . . . 34 Multiply line 3 by 80% (.80) . . . . . . . . . 45 Enter the retained worker's wages for the second 26



(a) Retained Worker

No.

(b) Retained Worker

No.

(c) Retained Worker

No.1 Enter the retained worker's social security number . 12 Enter the first date of employment from the retained


consecutive weeks of employment . . . . . . 34 Multiply line 3 by 80% (.80) . . . . . . . . . 45 Enter the retained worker's wages for the second 26



Form 5884-B (12-2010)





OMB No. 1545-0219


















For Paperwork Reduction Act Notice, see instructions. Cat. No. 13570D Form 5884 (2010)

TOTAL QUALIFIED WAGES



Alcohol and Cellulosic Biofuel Fuels Credit

Attach to your tax return.

OMB No. 1545-0231



Caution. You cannot claim any amounts on Form 6478 that you claimed (or will claim) on Form 720 (Schedule C), Form 8849, or Form 4136.

Type of Fuel(a)


(b) Rate


1 Qualified ethanol fuel production (see instructions for election) 1 2 Alcohol 190 proof or greater and alcohol 190 proof or greater

in fuel mixtures . . . . . . . . . . . . . . . . 2 3 Alcohol less than 190 proof but at least 150 proof and alcohol

less than 190 proof but at least 150 proof in fuel mixtures . . 3 4 Qualified cellulosic biofuel production that is alcohol (see

instructions for election) . . . . . . . . . . . . . 4 5 Qualified cellulosic biofuel production that is not alcohol (see

instructions for election) . . . . . . . . . . . . . 5 6 Reserve for future use . . . . . . . . . . . . . . 6

7 Add the amounts in column (c) on lines 1 through 5. Include this amount in your income for 2010 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8 Alcohol and cellulosic biofuel fuels credit from a partnership, S corporation, cooperative, estate, or trust (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . 8

9 Add lines 7 and 8. Partnerships and S corporations, report this amount on Schedule K. All others, go to line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Alcohol and cellulosic biofuel fuels credit included on line 9 from passive activities (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Subtract line 10 from line 9 . . . . . . . . . . . . . . . . . . . . . . . . 11 12 Alcohol and cellulosic biofuel fuels credit allowed for 2010 from a passive activity (see instructions) 12 13 Carryforward of any alcohol and cellulosic biofuel fuels credit that originated in a tax year that

began after 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Carryback of the alcohol and cellulosic biofuel fuels credit from 2011 (see instructions) . . . . 14 15 Add lines 11 through 14. Cooperatives, estates, and trusts, go to line 16. All others, report this

amount on Form 3800, line 29c . . . . . . . . . . . . . . . . . . . . . . 15 16 Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust (see

instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 17 Cooperatives, estates, and trusts. Subtract line 16 from line 15. Report this amount on Form 3800,

line 29c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 *Only the rate for ethanol is shown. See instructions for the rate for alcohol other than ethanol.**Only the rate for alcohol other than ethanol is shown. See instructions for the rate for ethanol.

For Paperwork Reduction Act Notice, see instructions. Cat. No. 13605J Form 6478 (2010)



Credit for Increasing Research Activities


OMB No. 1545-0619



Section A—Regular Credit. Skip this section and go to Section B if you are electing or previously elected (and are not revoking) the alternative simplified credit.

1 Certain amounts paid or incurred to energy consortia (see instructions) . . . . . . . . . 1 2 Basic research payments to qualified organizations (see instructions) . 2 3 Qualified organization base period amount . . . . . . . . . . 3 4 Subtract line 3 from line 2. If zero or less, enter -0- . . . . . . . . . . . . . . . . 4 5 Wages for qualified services (do not include wages used in figuring the

work opportunity credit) . . . . . . . . . . . . . . . . 5 6 Cost of supplies . . . . . . . . . . . . . . . . . . 6 7 Rental or lease costs of computers (see instructions) . . . . . . 7 8 Enter the applicable percentage of contract research expenses (see

instructions) . . . . . . . . . . . . . . . . . . . . 8 9 Total qualified research expenses. Add lines 5 through 8 . . . . . 9

10 Enter fixed-base percentage, but not more than 16% (see instructions) . 10 % 11 Enter average annual gross receipts (see instructions) . . . . . . 11 12 Multiply line 11 by the percentage on line 10 . . . . . . . . . 12 13 Subtract line 12 from line 9. If zero or less, enter -0- . . . . . . . 13 14 Multiply line 9 by 50% (.50) . . . . . . . . . . . . . . . 14 15 Enter the smaller of line 13 or line 14 . . . . . . . . . . . . . . . . . . . . 15 16 Add lines 1, 4, and 15 . . . . . . . . . . . . . . . . . . . . . . . . . . 16 17 Are you electing the reduced credit under section 280C? Yes No

If “Yes,” multiply line 16 by 13% (.13). If “No,” multiply line 16 by 20% (.20) and see theinstructions for the schedule that must be attached. Members of controlled groups or businessesunder common control: see instructions for the schedule that must be attached . . . . . . 17

Section B—Alternative Simplified Credit. Skip this section if you are completing Section A.

18 Certain amounts paid or incurred to energy consortia (see the line 1 instructions) . . . . . . 18 19 Basic research payments to qualified organizations (see the line 2

instructions) . . . . . . . . . . . . . . . . . . . . 19 20 Qualified organization base period amount (see the line 3 instructions) . 2021 Subtract line 20 from line 19. If zero or less, enter -0- . . . . . . . . . . . . . . . 2122 Add lines 18 and 21 . . . . . . . . . . . . . . . . . . . . . . . . . . 22 23 Multiply line 22 by 20% (.20) . . . . . . . . . . . . . . . . . . . . . . . 2324 Wages for qualified services (do not include wages used in figuring the

work opportunity credit) . . . . . . . . . . . . . . . . 24 25 Cost of supplies . . . . . . . . . . . . . . . . . . 2526 Rental or lease costs of computers (see the line 7 instructions) . . . 26 27 Enter the applicable percentage of contract research expenses (see the

line 8 instructions) . . . . . . . . . . . . . . . . . . 27 28 Total qualified research expenses. Add lines 24 through 27 . . . . 2829 Enter your total qualified research expenses for the prior 3 tax years. If

you had no qualified research expenses in any one of those years, skip lines 30 and 31 . . . . . . . . . . . . . . . . . . . 29

30 Divide line 29 by 6.0 . . . . . . . . . . . . . . . . . 3031 Subtract line 30 from line 28. If zero or less, enter -0- . . . . . . 3132 Multiply line 31 by 14% (.14). If you skipped lines 30 and 31, multiply line 28 by 6% (.06) . . . . 32

For Paperwork Reduction Act Notice, see instructions. Cat. No. 13700H Form 6765 (2010)


Form 6765 (2010) Page 2

Section B—Alternative Simplified Credit (continued).

33 Add lines 23 and 32 . . . . . . . . . . . . . . . . . . . . . . . . . . 3334 Are you electing the reduced credit under section 280C? Yes No

34

If “Yes,” multiply line 33 by 65% (.65). If “No,” enter the amount from line 33 and see the line 17 instructions for the schedule that must be attached. Members of controlled groups or businesses under common control: see instructions for the schedule that must be attached . . . . . .

Section C—Summary

35 Enter the portion of the credit from Form 8932, line 2, that is attributable to wages that were also used to figure the credit on line 17 or line 34 (whichever applies) . . . . . . . . . . . . 35

36 Subtract line 35 from line 17 or line 34 (whichever applies). If zero or less, enter -0- . . . . . 3637 Credit for increasing research activities from partnerships, S corporations, estates, and trusts . . 37 38 Add lines 36 and 37. Estates and trusts go to line 39; partnerships and S corporations, report this

amount on Schedule K; all others, report this amount on line 1c of Form 3800 . . . . . . . 3839 Amount allocated to beneficiaries of the estate or trust (see instructions) . . . . . . . . . 3940 Estates and trusts: subtract line 39 from line 38. Report the credit on line 1c of Form 3800 . . . 40

Form 6765 (2010)



Low-Income Housing Credit


OMB No. 1545-0984

2010Attachment Sequence No. 36a


Part I Buildings Placed in Service Before 20081 Number of Forms 8609-A attached for buildings placed in service before

2008 . . . . . . . . . . . . . . . . . . . . . . 2 Has there been a decrease in the qualified basis of any buildings accounted for on line 1 since

the close of the preceding tax year? Yes No If “Yes,” enter the buildingidentification numbers (BINs) of the buildings that had a decreased basis. If you need more space, attach a schedule.

(i) (ii) (iii) (iv)3 Current year credit from attached Form(s) 8609-A for buildings placed in service before 2008

(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Low-income housing credit for buildings placed in service before 2008 from partnerships, S

corporations, estates, and trusts . . . . . . . . . . . . . . . . . . . . . 45 Add lines 3 and 4. Estates and trusts, go to line 6; partnerships and S corporations, report this

amount on Schedule K; all others, report this amount on Form 3800, line 1d . . . . . . . 5


7 Estates and trusts. Subtract line 6 from line 5. Report this amount on Form 3800, line 1d . . 7Part II Buildings Placed in Service After 2007

8 Number of Forms 8609-A attached for buildings placed in service after 2007 . . . . . . . . . . . . . . . . . . . . . .

9 Has there been a decrease in the qualified basis of any buildings accounted for on line 8 since the close of the preceding tax year? Yes No If “Yes,” enter the buildingidentification numbers (BINs) of the buildings that had a decreased basis. If you need more space, attach a schedule.

(i) (ii) (iii) (iv)

10 Current year credit from attached Form(s) 8609-A for buildings placed in service after 2007 (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Low-income housing credit for buildings placed in service after 2007 from partnerships, S corporations, estates, and trusts. . . . . . . . . . . . . . . . . . . . . 11

12 Add lines 10 and 11. Partnerships and S corporations, report this amount on Schedule K; all others, continue to line 13 . . . . . . . . . . . . . . . . . . . . . . . 12

13 Low-income housing credit included on line 12 from passive activities (see instructions) . . . 13

14 Subtract line 13 from line 12 . . . . . . . . . . . . . . . . . . . . . . 14

15 Low-income housing credit allowed for 2010 from a passive activity (see instructions) . . . 15

16 Carryforward of low-income housing credit to 2010 (see instructions) . . . . . . . . . 16

17 Carryback of low-income housing credit from 2011 (see instructions) . . . . . . . . . 17 18 Add lines 14 through 17. Estates and trusts, go to line 19; all others, report this amount on

Form 3800, line 29d . . . . . . . . . . . . . . . . . . . . . . . . . 18


20 Estates and trusts. Subtract line 19 from line 18. Report this amount on Form 3800, line 29d . 20For Paperwork Reduction Act Notice, see instructions. Cat. No. 63987I Form 8586 (2010)


OMB No. 1545-1021Asset Acquisition Statement8594FormUnder Section 1060(Rev. February 2006)


AttachmentSequence No. 61� Attach to your income tax return.

Name as shown on return

SellerCheck the box hat identifies you:

1 Name of other party to the transaction Other party’s identifying number

Address (number, street, and room or suite no.)


Form 8594 (Rev. 2-2006)For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 63768Z

Purchaser

Identifying number as shown on return

General Information

2 Date of sale 3 Total sales price (consideration)

Part I

Part II Original Statement of Assets TransferredAllocation of sales priceAggregate fair market value (actual amount for Class I)Assets4

$$Class I

$$Class II

Class V $$

Total $

Did the purchaser and seller provide for an allocation of the sales price in the sales contract or in anotherwritten document signed by both parties?

5NoYes

If “Yes,” are the aggregate fair market values (FMV) listed for each of asset Classes I, II, III, IV, V, VI, andVII the amounts agreed upon in your sales contract or in a separate written document? Yes No

In the purchase of the group of assets (or stock), did the purchaser also purchase a license or a covenantnot to compete, or enter into a lease agreement, employment contract, management contract, or similararrangement with the seller (or managers, directors, owners, or employees of the seller)?

6

NoYes

If “Yes,” attach a schedule that specifies (a) the type of agreement and (b) the maximum amount ofconsideration (not including interest) paid or to be paid under the agreement. See instructions.

$

$$Class IV

$$Class VI and VII

$$Class III


NUMBER OF 8594 FORMSSUB


Form

OMB No. 1545-0988 Annual Statement for Low-Income Housing Credit

� File with owner’s federal income tax return. (Rev. December 2008) Attachment Department of the Treasury




1 1 Eligible basis of building

. 2 2 Low-income portion (smaller of unit fraction or floor space fraction) (if first year of the credit

period, see instructions) 3 3 Qualified basis of low-income building. Multiply line 1 by line 2 (see instructions for exceptions)

4 Part-year adjustment for disposition or acquisition during the tax year

4 . 5 5 Credit percentage

6 Multiply line 3 or line 4 by the percentage on line 5

6 7 7 Additions to qualified basis, if any

8 8 9 . 9

10 10 Multiply line 7 or line 8 by the percentage on line 9 11 11 Section 42(f)(3)(B) modification

12 12 Add lines 10 and 11 13 13 Credit for building before line 14 reduction. Subtract line 12 from line 6

14 14 Disallowed credit due to federal grants (see instructions)

15 15 Credit allowed for building for tax year. Subtract line 14 from line 13, but do not enter more than

the amount shown on Form 8609, Part I, line 1b 16 Taxpayer’s proportionate share of credit for the year (see instructions)

16 17 18

Adjustments for deferred first-year credit (see instructions)

17 Taxpayer’s credit. Combine lines 16 and 17. Enter here and on Form 8586 (see instructions)

Sequence No. 36

Credit percentage. Enter one-third of the percentage on line 5

Cat No. 38841T

18 Form 8609-A (Rev. 12-2008)

Part-year adjustment for disposition or acquisition during the tax year

B

A

C

Building identification number (BIN) �

This Form 8609-A is for (check the box) � a newly constructed or existing building section 42(e) rehabilitation expenditures Do you have in your records the original Form 8609 (or a copy thereof) signed and issued by the housing creditagency for the building in A?

If “No,” see the instructions and stop here—do not go to Part II. Did the building in A qualify as a part of a qualified low-income housing project and meet the requirements ofsection 42 as of the end of the tax year for which this form is being filed?

If “No,” see the instructions and stop here—do not go to Part II. Was there a decrease in the qualified basis of the building in A for the tax year for which this form is beingfiled?

If “Yes,” see the instructions. If “No,” and the entire credit has been claimed in prior tax years, stop here—do not go to Part II.

D

E

Yes No Part I

Part II

Compliance Information

Computation of Credit

8609-A � See separate instructions.


Form 8611(Rev. January 2011) Department of the Treasury Internal Revenue Service

Recapture of Low-Income Housing Credit Attach to your return.

Note: Complete a separate Form 8611 for each building to which recapture applies.

OMB No. 1545-1035


A Name(s) shown on return B Identifying number

C Address of building (as shown on Form 8609) D Building identification number (BIN)

E Date placed in service (from Form 8609)

F If building is financed in whole or part with tax-exempt bonds, see instructions and furnish:

(1) Issuer’s name

(2) Date of issue

(3) Name of issue (4) CUSIP number

Note: Skip lines 1–7 and go to line 8 if recapture is passed through from a flow-through entity (partnership, S corporation, estate, or trust).

1 Enter total credits reported on Form 8586 in prior years for this building . . . . . . . . 1

2 Credits included on line 1 attributable to additions to qualified basis (see instructions) . . . 2

3 Credits subject to recapture. Subtract line 2 from line 1 . . . . . . . . . . . . . . 3

4 Credit recapture percentage (see instructions) . . . . . . . . . . . . . . . . . 4 .

5 Accelerated portion of credit. Multiply line 3 by line 4 . . . . . . . . . . . . . . 5 6 Percentage decrease in qualified basis. Express as a decimal amount carried out to at least 3

places (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 6 .

7 Amount of accelerated portion recaptured (see instructions if prior recapture on building). Multiply line 5 by line 6. Section 42(j)(5) partnerships, go to line 16. All other flow-through entities (except electing large partnerships), enter the result here and enter each recipient’s share in the appropriate box of Schedule K-1. Generally, flow-through entities other than electing large partnerships will stop here. (Note: An estate or trust enters on line 8 only its share of recapture amount attributable to the credit amount reported on its Form 8586.) . . . . . 7

8 Enter recapture amount from flow-through entity (see Note above) . . . . . . . . . . 8

9 Enter the unused portion of the accelerated amount from line 7 (see instructions) . . . . . 9

10 Net recapture. Subtract line 9 from line 7 or line 8. If less than zero, enter -0- . . . . . . 10

11 Enter interest on the line 10 recapture amount (see instructions) . . . . . . . . . . . 11

12 Total amount subject to recapture. Add lines 10 and 11 . . . . . . . . . . . . . 12 13 Unused credits attributable to this building reduced by the accelerated portion included on line 9

(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Recapture tax. Subtract line 13 from line 12. If zero or less, enter -0-. Enter the result here and

on the appropriate line of your tax return (see instructions). If more than one Form 8611 is filed, add the line 14 amounts from all forms and enter the total on the appropriate line of your return. Electing large partnerships, see instructions . . . . . . . . . . . . . . . . . 14

15 Carryforward of the low-income housing credit attributable to this building. Subtract line 12 from line 13. If zero or less, enter -0- (see instructions) . . . . . . . . . . . . . . 15

Only Section 42(j)(5) partnerships need to complete lines 16 and 17.

16 Enter interest on the line 7 recapture amount (see instructions) . . . . . . . . . . . 16

17 Total recapture. Add lines 7 and 16 (see instructions) . . . . . . . . . . . . . . 17 For Paperwork Reduction Act Notice, see instructions. Cat. No. 63983Q Form 8611 (Rev. 1-2011)

SECONDARYREFERENCE


Special Loss Discount Account and SpecialEstimated Tax Payments for Insurance Companies

Form 8816 OMB No. 1545-1130 (Rev. January 2010)


� Attach to tax return. Employer Identification Number Name

Special Loss Discount Amount

Accident year

Balance at the beginning of the year

4

Undiscounted unpaid losses

1

Discounted unpaid losses

2 Special loss discount limitation.Subtract line 2 from line 1

3

Additions—section 847(4)

5

Subtractions—section 847(5)

6

Balance at the end of the year.Add lines 4 and 5 and subtract line6 from the result

7

Special Loss Discount Account (See instructions.)

Balance at the beginning of the year

8

Payments made for year

9

11 Payments applied for year Balance at the end of the year.

Add lines 8 through 10 andsubtract line 11 from the result

12

Special Estimated Tax Payments (See instructions.)


Part III

Part I

Part II

Cat. No. 41382N

Form 8816 (Rev. 1-2010)

10 Prior section 847 paymentstransferred to current year

General Instructions Section references are to the InternalRevenue Code. Purpose of form. Form 8816 must befiled by insurance companies that electto take an additional deduction undersection 847.

When to file. Attach Form 8816 to theForm 1120-PC, Form 1120-L, or Form1120 filed for the tax year of theadditional deduction and for eachsubsequent tax year that has aremaining amount of unpaid lossesresulting from the deduction.

Consolidated return. Each member of aconsolidated group claiming a section847 deduction must file a separate Form8816. Do not combine several taxpayerson one Form 8816. If a consolidatedreturn is filed on Form 1120 and one or

more members of the group is claiminga section 847 deduction, enter “Form8816” and the amount in the marginnear line 32b on Form 1120. This willassist the IRS in properly accounting foryour Special Estimated Tax Payments.


Part I. Special Loss DiscountAmount

Note: Line references are to the 2009Form 1120-L, 2009 Form 1120-PC, and2009 Form 1120.

Accident year. Enter the four digitaccident year in the space provided atthe top of each column. For example,enter accident year 2008 as 2008.

AMOUNTS TAKEN FROM

ALL YEARS AVAILABLE


OMB No. 1545-1505 Orphan Drug Credit 8820 Form

� Attach to your tax return. AttachmentSequence No. 103

Department of the TreasuryInternal Revenue Service Identifying number Name(s) shown on return

1 1

2a 2a

3

4

3

4

Form 8820 (Rev. 12-2008) Cat. No. 11208S

Qualified clinical testing expenses paid or incurred during the tax year

Current year credit. Multiply line 1 by 50% (.50) (see instructions)

Orphan drug credit from partnerships, S corporations, estates, or trusts

Add lines 2c and 3. Estates and trusts go to line 5. Partnerships and S corporations, report this amount on Schedule K. All others, report this amount on the applicable line of Form 3800 (e.g., line 1h of the 2008 Form 3800)

For Paperwork Reduction Act Notice, see back of form.


5 Amount allocated to the beneficiaries of the estate or trust (see instructions)

6 Estates and trusts. Subtract line 5 from line 4. Report this amount on the applicable line of Form 3800 (e.g., line 1h of the 2008 Form 3800)

5

6

2b

b Enter the amount from the employer differential wage credit line of Form 3800 (e.g., line 1w ofthe 2008 Form 3800) that is attributable to employees whose wages were used to figure thecredit on line 2a above

2c c Subtract line 2b from 2a. If zero or less, enter -0-





OMB No. 1545-1190


2010










7 Was the exchange of the property given up or received made with a related party, either directly or ind tly (such as through an intermediary)? See instructions. If “Yes,” complete Part II. If “No,” go to Part III . Yes No





















26 Enter the number from the upper right corner of your certificate of divestiture. (Do not attach a copy of your certificate. Keep the certificate with your records.) . . . . . . . . . . � –

27 Description of divested property �

28 Description of replacement property �


30 Sales price of divested property (see instructions) . . . . . . 30



of sale . . . . . . . . . . . . . . . . . . . . 33






MULTI-ASSET EXCHANGES


Form 8825 (Rev. December 2010) Department of the Treasury Internal Revenue Service

Rental Real Estate Income and Expenses of a Partnership or an S Corporation

See instructions on back. Attach to Form 1065, Form 1065-B, or Form 1120S.

OMB No. 1545-1186

Name Employer identification number

1 Show the type and address of each property. For each rental real estate property listed, report the number of days rented at fair rental value and days with personal use. See instructions. See page 2 to list additional properties. Physical address of each property—street, city, state, ZIP code

Type—Enter code 1-8; see page 2 for list

Fair Rental Days Personal Use Days

A

B

C

D

Properties Rental Real Estate Income A B C D

2 Gross rents . . . . . . . 2

Rental Real Estate Expenses 3 Advertising . . . . . . . 3 4 Auto and travel . . . . . 4 5 Cleaning and maintenance . . 5 6 Commissions . . . . . . 6 7 Insurance . . . . . . . 7 8 Legal and other professional fees 8 9 Interest . . . . . . . . 9

10 Repairs . . . . . . . . 10 11 Taxes . . . . . . . . 11 12 Utilities . . . . . . . . 12 13 Wages and salaries . . . . 13 14 Depreciation (see instructions) 14 15 Other (list)

15

16 Total expenses for each property.Add lines 3 through 15 . . . 16

17 Income or (Loss) from each property. Subtract line 16 from line 2 17

18a Total gross rents. Add gross rents from line 2, columns A through H . . . . . . . . . 18a b Total expenses. Add total expenses from line 16, columns A through H . . . . . . . . 18b ( )

19 Net gain (loss) from Form 4797, Part II, line 17, from the disposition of property from rental real estate activities . . . . . . . . . . . . . . . . . . . . . . . . . . 19

20a Net income (loss) from rental real estate activities from partnerships, estates, and trusts in which this partnership or S corporation is a partner or beneficiary (from Schedule K-1) . . . . . 20a

b Identify below the partnerships, estates, or trusts from which net income (loss) is shown on line 20a. Attach a schedule if more space is needed:

(1) Name (2) Employer identification number

21 Net rental estate income (loss). Combine lines 18a through 20a. Enter the result here and on: • Form 1065 or 1120S: Schedule K, line 2, or • Form 1065-B: Part I, line 4

21

For Paperwork Reduction Act Notice, see back of form. Cat. No. 10136Z Form 8825 (12-2010)

TOTAL FOR ALL PROPERTIES★


OMB No. 1545-1205 Disabled Access Credit 8826 Form



1 1 Total eligible access expenditures (see instructions) 2 250 00 $ Minimum amount

2

3 Subtract line 2 from line 1. If zero or less, enter -0-

3 4 $10,000 00 4 Maximum amount

5 Enter the smaller of line 3 or line 4

5 6 Multiply line 5 by 50% (.50)

6

Disabled access credit from partnerships and S corporations

7 7 8 Add lines 6 and 7, but do not enter more than $5,000. Partnerships and S corporations, report this

amount on Schedule K; all others, report this amount on the applicable line of Form 3800 (e.g., line1g of the 2006 Form 3800) 8

Form 8826 (Rev. 12-2006) Cat. No. 12774N





Credit for Prior Year Minimum Tax—Corporations

Attach to the corporation’s tax return.

OMB No. 1545-1257


1 Alternative minimum tax (AMT) for 2009. Enter the amount from line 14 of the 2009 Form 4626 1 2 Minimum tax credit carryforward from 2009. Enter the amount from line 9 of the 2009 Form 8827 2 3 Enter any 2009 unallowed qualified electric vehicle credit (see instructions) . . . . . . . 3 4 Add lines 1, 2, and 3 . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 Enter the corporation’s 2010 regular income tax liability minus allowable tax credits (see

instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6 Is the corporation a “small corporation” exempt from the AMT for 2010 (see instructions)?

• Yes. Enter 25% of the excess of line 5 over $25,000. If line 5 is $25,000 or less, enter -0-• No. Complete Form 4626 for 2010 and enter the tentative minimum tax from line 12 . . . 6

7 a Subtract line 6 from line 5. If zero or less, enter -0- . . . . . . . . . . . . . . . 7a b For a corporation electing to accelerate the minimum tax credit, enter the bonus depreciation

amount attributable to the minimum tax credit (see instructions) . . . . . . . . . . . 7bc Add lines 7a and 7b . . . . . . . . . . . . . . . . . . . . . . . . . 7c

8 a Enter the smaller of line 4 or line 7c. If the corporation had a post-1986 ownership change or has pre-acquisition excess credits, see instructions . . . . . . . . . . . . . . . 8a

b Current year minimum tax credit. Enter the smaller of line 4 or line 7a here and on Form 1120, Schedule J, line 5d (or the applicable line of your return). If the corporation had a post-1986 ownership change or has pre-acquisition excess credits, see instructions. If you made an entry on line 7b, go to line 8c. Otherwise, skip line 8c . . . . . . . . . . . . . . . . 8b

c Subtract line 8b from line 8a. This is the refundable amount for a corporation electing to accelerate the minimum tax credit. Include this amount on line 32g of Form 1120 (or theapplicable line of your return) . . . . . . . . . . . . . . . . . . . . . . 8c

9 Minimum tax credit carryforward to 2011. Subtract line 8a from line 4. Keep a record of thisamount to carry forward and use in future years . . . . . . . . . . . . . . . . 9

Cat. No. 13008K Form 8827 (2010)





OMB No. 1545-1374





(a) Vehicle 1

(b) Vehicle 2

(c) Vehicle 3







(a) Vehicle 1

(b) Vehicle 2

(c) Vehicle 3

14


15 Multiply line 14 by 10% (.10) . . . . . . . . . . 1516



credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21




Form 8834 (2010) Page 2Part II Qualified Electric Vehicle Credit

Caution. This part only applies to qualified electric vehicle passive activity credits from prior years (allowed on Form 8582-CR or Form 8810).

23 Qualified electric vehicle passive activity credits allowed for 2010 (see instructions) . . . . . 23

24 Regular tax before credits:• Individuals. Enter the amount from Form 1040, line 44, or Form 1040NR, line 42.• Corporations. Enter the amount from Form 1120, Schedule J, line 2; or the

applicable line of your return.• Estates and trusts. Enter the sum of the amounts from Form 1041, Schedule G,

lines 1a and 1b, or the amount from the applicable line of your return.} . . . . 24

25 Credits that reduce regular tax before the qualified electric vehicle credit:a Foreign tax credit . . . . . . . . . . . . . . . . . . 25ab Personal credits from Form 1040 or 1040NR (see instructions) . . . 25bc American Samoa economic development credit (Form 5735) . . . . 25cd Add lines 25a through 25c . . . . . . . . . . . . . . . . . . . . . . . . 25d

26 Net regular tax. Subtract line 25d from line 24. If zero or less, stop here; do not file this formunless you are claiming the qualified plug-in electric vehicle credit in Part I . . . . . . . . 26

27 Tentative minimum tax:• Individuals. Enter the amount from Form 6251, line 33.• Corporations. Enter the amount from Form 4626, line 12.• Estates and trusts. Enter the amount from Schedule I (Form 1041), line 54.

} . . . . . . 27

28 Subtract line 27 from line 26. If zero or less, stop here; do not file this form unless you are claiming the qualified plug-in electric vehicle credit in Part I . . . . . . . . . . . . . 28

29 Qualified electric vehicle credit. Enter the smaller of line 23 or line 28. Report the total of this amount and the amount, if any, from line 22 on Form 1040, line 53; Form 1040NR, line 50; Form 1120, Schedule J, line 5b; or the appropriate line of your return. If line 28 is smaller than line 23, see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . 29



Renewable Electricity, Refined Coal, and Indian Coal Production Credit

� See separate instructions. � Attach to your tax return.

OMB No. 1545-1362



Part I Electricity Produced at Qualified Facilities Placed in Service Prior to October 23, 20041 Kilowatt-hours produced and sold (see instructions) . . . � 0.022 12 Phaseout adjustment (see instructions) . . . . . . . $ � 23 Credit before reduction. Subtract line 2 from line 1 . . . . . . . . . . . . . . . 3

Reduction for government grants, subsidized financing, and other credits:4 Total of government grants, proceeds of tax-exempt government obligations, subsidized energy financing,

and any federal tax credits allowed for the project for this and all prior tax years (see instructions) . . . 45 Total of additions to the capital account for the project for this and all prior tax years . . . . 5 6 Divide line 4 by line 5. Show as a decimal carried to at least 4 places . . . . . . . . . 6 . 7 Multiply line 3 by line 6 . . . . . . . . . . . . . . . . . . . . . . . . 78 Subtract line 7 from line 3 . . . . . . . . . . . . . . . . . . . . . . . 89 Part I renewable electricity production credit from partnerships, S corporations, cooperatives,

estates, and trusts . . . . . . . . . . . . . . . . . . . . . . . . . . 910 Add lines 8 and 9. Cooperatives, estates, and trusts, go to line 11; partnerships and S corporations,

report this amount on Schedule K; all others, report this amount on Form 3800, line 1f . . . . 1011 Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust (see instructions) 1112 Cooperatives, estates, and trusts. Subtract line 11 from line 10. Report this amount on Form 3800, line 1f 12Part II Electricity and Refined Coal Produced at Qualified Facilities Placed in Service After

October 22, 2004 (After October 2, 2008, for Electricity Produced From Marine and Hydrokinetic Renewables), and Indian Coal Produced at Facilities Placed in Service After August 8, 2005

13




(b) Rate


a Wind . . . . . . . . 13a 0.022b Closed-loop biomass. . . . 13b 0.022c Geothermal . . . . . . 13c 0.022d Solar . . . . . . . . 13d 0.022e Add column (c) of lines 13a through 13d and enter here . . . . . . . . . . . . . . . 13e

14




(b) Rate


a Open-loop biomass . . . . 14a 0.011b Small irrigation power . . . 14b 0.011c Landfill gas. . . . . . . 14c 0.011d Trash . . . . . . . . 14d 0.011e Hydropower . . . . . . 14e 0.011f Marine and hydrokinetic

renewables . . . . . . 14f 0.011g Add column (c) of lines 14a through 14f and enter here . . . . . . . . . . . . . . . 14g

15 Add lines 13e and 14g . . . . . . . . . . . . . . . . . . . . . . . . . 1516 Phaseout adjustment (see instructions) . . . . . . . $ � 16 17 Subtract line 16 from line 15 . . . . . . . . . . . . . . . . . . . . . . 17

Refined coal produced at a qualified refined coal production facility18 Tons produced and sold (see instructions) . . . . . . � $6.27 18 19 Phaseout adjustment (see instructions) . . . . . . . $ � 19 20 Subtract line 19 from line 18 . . . . . . . . . . . . . . . . . . . . . . 20

Steel industry fuel produced at a qualified refined coal production facility21 Barrel-of-oil equivalents produced and sold (see instructions) � $2.87 21

Indian coal produced at a qualified Indian coal production facility22 Tons produced and sold (see instructions) . . . . . . � $2.20 22

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 14954R Form 8835 (2010)

23 Credit before reduction. Add lines 17, 20, 21, and 22 . . . . . . . . . . . . . . 23


Form 8835 (2010) Page 2Reduction for government grants, subsidized financing, and other credits:

24 Total of government grants, proceeds of tax-exempt government obligations, subsidized energy financing, and any federal tax credits allowed for the project for this and all prior tax years (see instructions) . . . 24

25 Total of additions to the capital account for the project for this and all prior tax years . . . . 2526 Divide line 24 by line 25. Show as a decimal carried to at least 4 places . . . . . . . . 26 .27 Multiply line 23 by the smaller of 1/2 or line 26 . . . . . . . . . . . . . . . . . 2728 Subtract line 27 from line 23 . . . . . . . . . . . . . . . . . . . . . . 2829 Part II renewable electricity, refined coal, and Indian coal production credit from partnerships,

S corporations, cooperatives, estates, and trusts . . . . . . . . . . . . . . . . 2930 Add lines 28 and 29. Partnerships and S corporations, report this amount on Schedule K; all

others continue to line 31 . . . . . . . . . . . . . . . . . . . . . . . 3031 Renewable electricity, refined coal, and Indian coal production credit included on line 30 from

passive activities (see instructions) . . . . . . . . . . . . . . . . . . . . 3132 Subtract line 31 from line 30 . . . . . . . . . . . . . . . . . . . . . . 3233 Renewable electricity, refined coal, and Indian coal production credit allowed for 2010 from a passive

activity (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . 3334 Carryforward of renewable electricity, refined coal, and Indian coal production credit to 2010 . . . 3435 Carryback of renewable electricity, refined coal, and Indian coal production credit from 2011 (see

instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

36 Add lines 32 through 35. Cooperatives, estates, and trusts, go to line 37; All others: For electricity, refined coal, or Indian coal produced during the 4-year period beginning on the date the facility was placed in service, report the applicable part of this amount on Form 3800, line 29e; for all other production of electricity, refined coal, or Indian coal, report the applicable part of this amount on Form 3800, line 1f . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

37 Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust (see instructions) 3738 Cooperatives, estates, and trusts. Subtract line 37 from line 36. For electricity, refined coal, or Indian coal

produced during the 4-year period beginning on the date the facility was placed in service, report the applicable part of this amount on Form 3800, line 29e; for all other production of electricity, refined coal, or Indian coal, report the applicable part of this amount on Form 3800, line 1f . . . . . . . . . . 38

Form 8835 (2010)





OMB No. 1545-1444



1 Enter the total qualified wages paid or incurred during the calendar year only (see instructions)a Qualified empowerment zone wages . . . . . . $ × 20% (.20) 1ab Qualified renewal community wages . . . . . . $ × 15% (.15) 1b

2 Add lines 1a and 1b. See instructions for the adjustment you must make to salaries and wages . . . 2







9 Carryback of empowerment zone and renewal community employment credit from 2011 (see instructions) 9







Indian Employment Credit


OMB No. 1545-1417



1 Total of qualified wages and qualified employee health insurance costs paid or incurred during thetax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Calendar year 1993 qualified wages and qualified employee health insurance costs (see instructions). If none, enter -0- . . . . . . . . . . . . . . . . . . . . . 2

3 Incremental increase. Subtract line 2 from line 1. If zero or less, enter -0- . . . . . . . . . 3 4 Multiply line 3 by 20% (.20) (see instructions for the adjustment you must make for salaries

and wages) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Indian employment credits from partnerships, S corporations, cooperatives, estates,

and trusts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Add lines 4 and 5. Cooperatives, estates, and trusts, go to line 7; partnerships and S corporations,

report this amount on Schedule K; all others, report this amount on Form 3800, line 1g . . . . 67 Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust (see

instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Cooperatives, estates, and trusts. Subtract line 7 from line 6. Report this amount on

Form 3800, line 1g . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

For Paperwork Reduction Act Notice, see back of form. Cat. No. 16146D Form 8845 (2010)





OMB No. 1545-1414

2010Attachment

Sequence No. 98Name(s) shown on return Identifying number




4 Multiply line 3 by 7.65% (.0765). If you had any tipped employees whose wages (including tips) exceeded $106,800 or were exempt from social security taxes, see instructions and check here . . . . . . . . . . . . . . . . . . . . . . . . . . 4








For Paperwork Reduction Act Notice, see back of form. Cat. No. 16148Z Form 8846 (2010)





OMB No. 1545-1924





Type of Fuel(a)


(b) Rate

(c)

Column (a) x Column (b)

1 Biodiesel (other than agri-biodiesel) . . . . . . . . . 1 2 Agri-biodiesel . . . . . . . . . . . . . . . . 23 Renewable diesel . . . . . . . . . . . . . . . 3 4 Biodiesel (other than agri-biodiesel) included in a biodiesel

mixture . . . . . . . . . . . . . . . . . . 4

5 Agri-biodiesel included in a biodiesel mixture . . . . . . 5

6 Renewable diesel included in a renewable diesel mixture . . 6

7 Qualified agri-biodiesel production . . . . . . . . . 7 8 Add lines 1 through 7. Include this amount in your income for 2010 (see instructions) . . . . . 89 Biodiesel and renewable diesel fuels credit from partnerships, S corporations, cooperatives,







OMB No. 1545-1700 Qualified Subchapter S Subsidiary Election

8869 Form


Employer identification number (EIN) Name of parent

Form 8869 (Rev. 12-2008) Cat. No. 28755K


Under penalties of perjury, I declare that I have examined this election, including accompanying schedules and statements, and to the best of my knowledge and belief,it is true, correct, and complete.




Telephone number of officer or legal

representative

Signature of officerof parent corporation �

( )

Part I

Part II

1a

Name and title of officer or legal representative whom the IRS may call for more information

5

2

6

Tax year ending (month and day) 3

Service center where last return was filed

4

Parent S Corporation Making the Election

EIN (if any) Name of subsidiary



7a

Date election is to take effect (month, day, year) (see instructions) �

11

8

Date incorporated 9

State of incorporation

10

Subsidiary Corporation for Which Election is Made (For additional subsidiaries, see instructions.)

Did the subsidiary previously file a federal income tax return? If “Yes,” complete lines 13a, 13b, and 13c �

12 Service center where last return was filed

13a

Was the subsidiary’s last return filed as part of a consolidated return? If “Yes,” complete lines 16a, 16b, and 16c �

15

Tax year ending date of last

return (month, day, year) �

13b

Check type of return filed:

13c

Service center where consolidated return was filed

16c

16b

EIN of common parent

16a

Name of common parent

Title �

Date �

Yes

No

Yes

No

/ /

/ /

Form 1120S

Other �

Form 1120

(Under section 1361(b)(3) of the Internal Revenue Code)

b

c

b

c

Is this election being made in combination with a section 368(a)(1)(F) reorganization described in Rev. Rul. 2008-18, where the subsidiarywas an S corporation immediately before the election and a newly formed holding company will be the subsidiary’s parent? �

14 Yes

No


Form

8874



Cat. No. 31663N

Form 8874 (Rev. 1-2007)


Identifying number

(e)

Creditrate




number of CDE



1


3

%

%

%

3


2


2

(Rev. January 2007)


OMB No. 1545-1804

New Markets Credit


%

%

%

Generally, a qualified CDE can designate an equityinvestment as a qualified equity investment only if it appliedfor and received a new markets credit allocation and enteredinto an allocation agreement with the CDFI Fund before theequity investment was made.

Qualified CDEs also include specialized small businessinvestment companies and community development financialinstitutions. See section 45D(c)(2).

Exceptions. An equity investment in an entity that otherwisequalifies as a qualified equity investment is eligible to bedesignated as a qualified equity investment if made prior to anallocation agreement only if either of the following applies. ● The equity investment was made on or after April 20, 2001,and the designation of the equity investment as a qualifiedequity investment is made for a credit allocation receivedunder an allocation application submitted to the CDFI Fund nolater than August 29, 2002. If the entity in which the equityinvestment is made does not receive an allocation under anallocation application submitted no later than August 29, 2002,the equity investment will not be eligible to be designated as aqualified equity investment. For details, see Regulationssections 1.45D-1(c)(3)(ii)(A) and 1.45D-1(c)(3)(iii).

Qualified Equity Investment A qualified equity investment is an interest in a qualified CDEin the form of stock (other than nonqualified preferred stock) ina corporation or a capital interest in a partnership that meetsall of the following requirements. ● You acquired the investment solely for cash at its originalissue (or from a taxpayer for whom the investment was aqualified equity investment). The cash may be from borrowedfunds, including a nonrecourse loan. ● Substantially all (at least 85%) of the cash is used to makequalified low-income community investments. The 85%requirement is reduced to 75% for the seventh year of the7-year credit period. ● The investment was designated as a qualified equityinvestment by the CDE on its books and records for purposesof the new markets credit.


Use Form 8874 to claim the new markets credit for qualifiedequity investments made in qualified community developmententities (CDEs). This credit is part of the general businesscredit.

What’s New

Section references are to the Internal Revenue Code unlessotherwise noted.

Purpose of Form

A qualified CDE is a domestic corporation or partnership thatmeets the following requirements. ● Its primary mission is serving, or providing investmentcapital for, low-income communities or persons. ● It maintains accountability to residents of low-incomecommunities through their representation on any governingboard or advisory board of the entity. ● It is certified as a qualified CDE by the CommunityDevelopment Financial Institutions (CDFI) Fund of theDepartment of the Treasury.

Qualified CDE

● The tax liability limit is no longer figured on this form.Instead, it must be figured on Form 3800, General BusinessCredit. ● Taxpayers that are not partnerships or S corporations, andwhose only source of this credit is from those pass-throughentities, are not required to complete or file this form. Instead,they can report this credit directly on line 1l of Form 3800. ● The IRS will revise the January 2007 version of the form onlywhen necessary. Continue to use this version for tax yearsbeginning after 2005 until a new revision is issued.

Definitions

TIP

Qualified CDEs must provide taxpayers holding aqualified equity investment with a completed Form8874-A when a qualified equity investment isacquired.

Total Qualified Equity Investment


OMB No. 1545-1810

Credit for Small Employer Pension PlanStartup Costs

Form 8881 � Attach to your tax return.



Identifying number Name(s) shown on return

1

2 2 3

4

5

Form 8881 (Rev. 12-2006)

Qualified startup costs incurred during the tax year. Do not enter more than $1,000

3 Credit for small employer pension plan startup costs from partnerships and S corporations

5 Enter the smaller of line 4 or $500. Partnerships and S corporations, report this amount onSchedule K; all others report this amount on the applicable line of Form 3800, (e.g., line 1m ofthe 2006 Form 3800)

Cat. No. 33435N

Enter one-half of line 1

4

1

Add lines 2 and 3




OMB No. 1545-1809 Credit for Employer-Provided Childcare

Facilities and Services

8882

Form

Department of the TreasuryInternal Revenue Service Identifying number


Form 8882 (Rev. 12-2006)

Cat. No. 33436Y


AttachmentSequence No.131


1

2 2

3

5

Qualified childcare facility expenditures paid or incurred (seeinstructions)

3

5

Enter the smaller of line 6 or $150,000. Estates and trusts, go to line 8. All others report thisamount as follows: partnerships and S corporations, report this amount on Schedule K; allothers, report the credit on the applicable line of Form 3800, (e.g., line 1n of the 2006 Form3800)

Enter 25% (.25) of line 1

4

1

Add lines 2, 4, and 5

Qualified childcare resource and referral expenditures paid or incurred


6

7

6

7

4

Credit for employer-provided childcare facilities and services from partnerships, S corporations, estates, and trusts (see instructions)


Amount allocated to beneficiaries of the estate or trust (see instructions) 8

Estates and trusts. Subtract line 8 from line 7. Report the credit on the applicable line of Form3800 (e.g., line 1n of the 2006 Form 3800)

9

8

9


OMB No. 1545-1914 Low Sulfur Diesel Fuel Production Credit 8896 Form



1 1 Low sulfur diesel fuel produced (in gallons) 2 Multiply line 1 by $.05

2

5 6

Qualified costs limitation (see instructions)

3

6

Form 8896 (Rev. 1-2008)

Enter the smaller of line 5 or line 2

Cat. No. 37704F

Section references are to the InternalRevenue Code.

Use Form 8896 to claim the low sulfurdiesel fuel production credit.


Purpose of Form


Total low sulfur diesel fuel production credits allowed for all prior tax years


5

8 Add lines 6 and 7. Cooperatives go to line 9; partnerships and S corporations, report this amount on Schedule K; all others, report this amount on the applicable line of Form 3800 (e.g., line 1nof the 2007 Form 3800)

8

3 4

7

7

Low sulfur diesel fuel production credit from partnerships, S corporations, and cooperatives

The credit generally is 5 cents for everygallon of low sulfur diesel fuel produced bya qualified small business refiner during thetax year. However, the total credits allowedfor all tax years cannot be more than therefiner’s qualified costs limitation on line 3.This credit is part of the general businesscredit.

Definitions This is diesel fuel with a sulfur content of15 parts per million or less.

Low Sulfur Diesel Fuel

exceed 205,000 barrels for the 1-yearperiod ending on December 31, 2002. Tofigure the average daily domestic refineryrun or retained production, only includerefineries that were refineries of the refineror a related person (within the meaning ofsection 613A(d)(3)) on April 1, 2003.However, a refiner is not a small businessrefiner for a tax year if more than 1,500individuals are engaged in the refineryoperations of the business on any dayduring the tax year.

(Rev. January 2008)

9 Amount allocated to the patrons of the cooperative

9 10 Subtract line 9 from line 8. Report this amount on the applicable line of Form 3800 (e.g., line 1n

of the 2007 Form 3800)

10

What’s New ● Rev. Proc. 2007-69 provides guidanceon obtaining the required certification. SeeQualified Costs. ● The Tax Technical Corrections Act of2007 clarified the adjustment requiredwhen you deduct qualified costs undersection 179B and also claim this credit intax years ending after December 31, 2002.See TIP on this page.

A small business refiner generally is arefiner of crude oil with an average dailydomestic refinery run or average retainedproduction for all facilities that did not

Small Business Refiner

For each facility, qualified costs are costspaid or incurred to comply with thehighway diesel fuel sulfur controlrequirements of the EnvironmentalProtection Agency (EPA) during the periodbeginning January 1, 2003, and ending onthe earlier of:

Qualified Costs

For more information, see section 45H.

Additional Information

● The date 1 year after the date on whichthe refiner must comply with these EPArequirements with respect to such facilityor ● December 31, 2009.

Qualified costs include costs for theconstruction of new process operationunits or the dismantling and reconstructionof existing process units to be used in theproduction of low sulfur diesel fuel,associated adjacent or offsite equipment(including tankage, catalyst, and powersupply), engineering, construction periodinterest, and site work. In addition, the small business refinermust obtain certification from the IRS(which will consult with the EPA) that thetaxpayer’s qualified costs will result incompliance with the applicable EPAregulations. This certification must beobtained not later than June 29, 2008, or,if later, the date that is 30 months after thefirst day of the first tax year in which thecredit is determined. For details, see Rev.Proc. 2007-69 (available in I.R.B. 2007-49at www.irs.gov/irb).

Specific Instructions Use lines 1 through 6 to figure any lowsulfur diesel fuel production credit fromyour own trade or business. Cooperative Election To AllocateCredit to Patrons A cooperative described in section 1381(a)can elect to allocate any part of the lowsulfur diesel fuel production credit amongthe patrons of the cooperative. To makethe election, attach a statement to theeffect that the cooperative elects toallocate the credit among the patronseligible to share in patronage dividends onthe basis of the quantity or value ofbusiness done with or for the patrons forthe tax year. The election is not effective unless:

● Made on a timely filed return (includingextensions). However, if the cooperativemade an election on a tax return for a taxyear ending after December 31, 2002, andfiled before June 15, 2006, but failed toattach the required statement, thecooperative may attach that statement tothe first federal income tax return it filesafter June 14, 2006.

TIP

Unless you elect not to take thiscredit, your deductions will bereduced by the amount of yourcredit. For details, see section

280C(d).

● The cooperative designates theapportionment in a written notice mailedto its patrons during the payment perioddescribed in section 1382(d).

Taxpayers that are not partnerships, Scorporations, or cooperatives, and whoseonly source of this credit is from thosepass-through entities, are not required tocomplete or file this form. Instead, theycan report this credit directly on Form3800.



Domestic Production Activities Deduction� Attach to your tax return. � See separate instructions.

OMB No. 1545-1984




(b) All activities

1 Domestic production gross receipts (DPGR) . . . . . . . . . 1 2 Allocable cost of goods sold. If you are using the small business

simplified overall method, skip lines 2 and 3 . . . . . . . . 2 3 Enter deductions and losses allocable to DPGR (see instructions) . 3 4 If you are using the small business simplified overall method, enter the

amount of cost of goods sold and other deductions or losses you ratably apportion to DPGR. All others, skip line 4 . . . . . . . 4




instructions) . . . . . . . . . . . . . . . . . . 9 10 a Oil-related qualified production activities income. Estates and

trusts, subtract line 9, column (a), from line 8, column (a), all others, enter amount from line 8, column (a). If zero or less, enter -0- here . 10a

b Qualified production activities income. Estates and trusts, subtract line 9, column (b), from line 8, column (b), all others, enter amount from line 8, column (b). If zero or less, enter -0- here, skip lines 11through 21, and enter -0- on line 22 . . . . . . . . . . . 10b

11 Income limitation (see instructions):• Individuals, estates, and trusts. Enter your adjusted gross income figured without the domestic production activities deduction . . . . . . . . . . . . . . . . � 11 • All others. Enter your taxable income figured without the domestic production activities deduction (tax-exempt organizations, see instructions) . . . . . . . . . . .


13 Enter 9% of line 12 . . . . . . . . . . . . . . . . . . . . . . . . 13

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 37712F Form 8903 (Rev. 12-2010)

14 a Enter the smaller of line 10a or line 12 . . . . . . . . . . . 14ab Reduction for oil-related qualified production activities income. Multiply line 14a by 3% . . 14b

15 Subtract line 14b from line 13 . . . . . . . . . . . . . . . . . . . . . . 1516 Form W-2 wages (see instructions) . . . . . . . . . . . . . . . . . . . . 1617 Form W-2 wages from estates, trusts, and certain partnerships and S corporations

(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 1718 Add lines 16 and 17. Estates and trusts, go to line 19, all others, skip line 19 and go to line 20 1819 Amount allocated to beneficiaries of the estate or trust (see instructions) . . . . . . . 1920 Estates and trusts, subtract line 19 from line 18, all others, enter amount from line 18 . . . 2021 Form W-2 wage limitation. Enter 50% of line 20 . . . . . . . . . . . . . . . . 2122 Enter the smaller of line 15 or line 21 . . . . . . . . . . . . . . . . . . . 2223 Domestic production activities deduction from cooperatives. Enter deduction from Form





Alternative Motor Vehicle Credit See separate instructions. Attach to your tax return.

OMB No. 1545-1998



Note.• Use this form to claim the credit for certain alternative motor vehicles or plug-in electric vehicle conversions.• Claim the credit for certain two- or three-wheeled or low-speed four-wheeled plug-in electric vehicles on Form 8834.• Claim the credit for certain other plug-in electric vehicles on Form 8936.





3 Credit allowable (see instructions for amount to enter) 3 4

If you are not claiming the plug-in conversion credit, skip lines 4 through 8, enter -0- on line 9, and go to line 10. Otherwise, enter the cost of converting the vehicle to a qualified plug-in electric drive motor vehicle . . . . 4

5 Section 179 expense deduction (see instructions) . . 56 Subtract line 5 from line 4 . . . . . . . . . . 67 Multiply line 6 by 10% (.10) . . . . . . . . . 78 Maximum plug-in conversion credit amount allowable . 8 4,000 00 4,000 00 4,000 009 Enter the smaller of line 7 or line 8 . . . . . . . 9

10 Tentative credit. Add lines 3 and 9 . . . . . . . 10

/ / / / / /







16






Sum of columns (a) thru (c





OMB No. 1545-1981

2010Attachment





1 Total cost of qualified alternative fuel vehicle refueling property placed in service during the tax year . . . . . . . . . . . . . . . 1


2 Business/investment use part (see instructions) . . . . . . . 2 3 Section 179 expense deduction (see instructions) . . . . . . 3 4 Subtract line 3 from line 2 . . . . . . . . . . . . . . 4 5 Applicable credit rate decimal amount . . . . . . . . . . 5 .30 .506 Multiply line 4 by the applicable decimal amount on line 5 . . . . 67 Maximum business/investment use part of credit (see instructions) . 78 Enter the smaller of line 6 or line 7. . . . . . . . . . . . 89 Add columns (a) and (b) on line 8 . . . . . . . . . . . . . . . . . . . . 9

10 Alternative fuel vehicle refueling property credit from partnerships and S corporations . . . 1011 Business/investment use part of credit. Add lines 9 and 10. Partnerships and S corporations,

report this amount on Schedule K; all others, report this amount on Form 3800, line 1s . . . . . 11


12 Subtract line 2 from line 1. If zero, stop here; do not file this form unless you are claiming a credit on line 11 . . . . . . . . . 12

13 Applicable credit rate decimal amount . . . . . . . . . . 13 .30 .5014 Multiply line 12 by the applicable decimal amount on line 13 . . . 1415 Maximum personal use part of credit (see instructions) . . . . . 1516 Enter the smaller of line 14 or line 15 . . . . . . . . . . 1617 Add columns (a) and (b) on line 16 . . . . . . . . . . . . . . . . . . . . 1718 Regular tax before credits:

• Individuals. Enter the amount from Form 1040, line 44 (or Form 1040NR, line 42) • Other filers. Enter the regular tax before credits from your return . . . . � . . . .



20 Net regular tax. Subtract line 19d from line 18. If zero or less, stop here; do not file this formunless you are claiming a credit on line 11 . . . . . . . . . . . . . . . . . 20


� . . . 21

22 Subtract line 21 from line 20. If zero or less, stop here; do not file this form unless you are claiming a credit on line 11 . . . . . . . . . . . . . . . . . . . . . . 22

23 Personal use part of credit. Enter the smaller of line 17 or line 22 here and on Form1040, line 53; Form 1040NR, line 50; or the appropriate line of your return. If line 22 is smaller than line 17, see instructions . . . . . . . . . . . . . . . . . . . . . 23



Form



Reconciliation of Schedule M-3 Taxable Incomewith Tax Return Taxable Income for Mixed Groups � Attach to Schedule M-3 for Forms 1120, 1120-L, or 1120-PC.

OMB No. 1545-2062

Name of common parent



Form 8916 (Rev. 12-2008)

1

2a

3

5 6 7 8

4a

b

e

b

Enter the tax reconciliation amount from the applicable line of ScheduleM-3 (see instructions)

Life/non-life loss limitation amount

Limitation on non-insurance losses (Form 1120-L, page 1, line 25) Amount subtracted from policyholders surplus account (Form 1120-L,

page 1, line 26)

c

Combine lines 1 through 2f(2)

(1) Non-life net operating loss deduction

(1) Non-life dividends received deduction

Small life insurance company deduction (Form 1120-L, page 1, line 23)

Add lines 4a(1) through 4e


Other adjustments to reconcile to taxable income on tax return (attach schedule)

Total. Combine lines 6 and 7. This amount must equal the amount reported on the “Taxableincome” line of the consolidated Form 1120, Form 1120-L, or Form 1120-PC (see instructions)

1

2a

3

5 6 7

8

2b 2c

4a(1)

4b(1)

4e

(1) Non-life capital loss limitation

d

2d(1)

(2) Life capital loss limitation

2d(2)

(2) Life operations loss deduction

4a(2)

(2) Life dividends received deduction

4b(2)

c

(1) Non-life capital loss carryforward used

4c(1)

(2) Life capital loss carryforward used

d

(1) Non-life charitable deduction carryforward used

(2) Life charitable deduction carryforward used

4c(2) 4d(1) 4d(2)

(1) Non-life charitable deduction limitation

e

(2) Life charitable deduction limitation

2e(1) 2e(2)

(1) Non-life dual consolidated loss amount disallowed

f

(2) Life dual consolidated loss amount disallowed

2f(1) 2f(2)

Cat. No. 37727E



Form 8916-ADepartment of the Treasury Internal Revenue Service

Supplemental Attachment to Schedule M-3

Attach to Schedule M-3 for Form 1065, 1120, 1120-L, 1120-PC, or 1120S.

OMB No. 1545-2061

2010Name of common parent Employer identification number

Name of subsidiary Employer identification number

Part I Cost of Goods Sold

Cost of Goods Sold Items(a)




(d) Deduction per Tax

Return

1 Amounts attributable to cost flow assumptions .

2 Amounts attributable to:

a Stock option expense . . . . . . . . . .

b Other equity based compensation . . . . . .

c Meals and entertainment . . . . . . . . .

d Parachute payments . . . . . . . . . .

e Compensation with section 162(m) limitation . .

f Pension and profit sharing . . . . . . . .

g Other post-retirement benefits . . . . . . .

h Deferred compensation . . . . . . . . .

i Section 198 environmental remediation costs . .

j Amortization . . . . . . . . . . . . .

k Depletion . . . . . . . . . . . . . .

l Depreciation . . . . . . . . . . . . .

m Corporate owned life insurance premiums . . .

n Other section 263A costs . . . . . . . . .

3 Inventory shrinkage accruals. . . . . . . .

4 Excess inventory and obsolescence reserves

5 Lower of cost or market write-downs . . . . .

6 Other items with differences (attach schedule) . .

7 Other items with no differences . . . . . . .

8

Total cost of goods sold. Add lines 1 through 7, in columns a, b, c, and d . . . . . . . . . .

For Paperwork Reduction Act Notice, see page 4. Cat. No. 48657X Form 8916-A (2010)


Form 8916-A (2010) Page 2Part II Interest Income

Interest Income Item(a)





Tax Return

1

Tax-exempt interest income

2

Interest income from hybrid securities

3 Sale/lease interest income

4a

Intercompany interest income — From outside tax affiliated group

4b

Intercompany interest income — From tax affiliated group

5 Other interest income

6

Total interest income. Add lines 1 through 5. Enter total on Schedule M-3 (Forms 1120, 1120-PC, and 1120-L), Part II, line 13 or Schedule M-3 (Forms 1065 and 1120S) Part II, line 11.

Part III Interest Expense

Interest Expense Item(a)




(d) Deduction per Tax Return

1

Interest expense from hybrid securities

2

Lease/purchase interest expense

3a

Intercompany interest expense — Paid to outside tax affiliated group

3b

Intercompany interest expense — Paid to tax affiliated group

4 Other interest expense

5

Total interest expense. Add lines 1 through 4. Enter total on Schedule M-3 (Form 1120) Part III, line 8; Schedule M-3 (Forms 1120-PC and 1120-L), Part III, line 36; Schedule M-3 (Form 1065) Part III, line 27; or Schedule M-3 (Form 1120S) Part III, line 26.

Form 8916-A (2010)


OMB No. 1545-2089

Report of Employer-Owned Life Insurance Contracts 8925

Form


Name of policyholder, if different from above

Identifying number, if different from above

(99)


Cat. No. 37737A

Form 8925 (1-2008)

(January 2008)

� Attach to the policyholder’s tax return—See instructions.

Type of business

Enter the number of employees the policyholder had at the end of the tax year Enter the number of employees included on line 1 who were insured at the end of the tax

year under the policyholder’s employer-owned life insurance contract(s) issued after August 17, 2006. See Section 1035 exchanges below for an exception

Enter the total amount of employer-owned life insurance in force at the end of the tax year for employees who were insured under the contract(s) specified on line 2

Does the policyholder have a valid consent (see instructions) fo eachemployee included on line 2?

If “No,” enter the number of employees included on line 2 for whom the policyholder doesnot have a valid consent

1 2

3

4a

b

1

2

3

4b


Yes No


Identifying number

General Instructions Section references are to the InternalRevenue Code unless otherwise noted. Purpose of Form Use Form 8925 to report the number ofemployees covered byemployer-owned life insurancecontracts issued after August 17, 2006,and the total amount ofemployer-owned life insurance in forceon those employees at the end of thetax year. Policyholders must alsoindicate whether a valid consent hasbeen received from each coveredemployee, and the number of coveredemployees for which a valid consenthas not been received. See section6039I for more information.

Employer-owned life insurancecontract. For purposes of Form 8925,an insurance contract is anemployer-owned life insurancecontract if it is owned by a policyholderas defined below, and covers the life ofthe policyholder’s employee(s) on thedate the life insurance contract isissued. If you have master contracts,see section 101(j)(3) for additionalinformation. Policyholder. Generally, a policyholderis a person who is (a) engaged in atrade or business that employs theperson insured under theemployer-owned life insurancecontract and (b) the direct or indirectbeneficiary of the employer-owned lifeinsurance contract.

Employee. Employee includes anofficer, director, or highly compensatedemployee under section 414(q). Insured. An individual must be a U.S.citizen or resident to be consideredinsured under an employer-owned lifeinsurance contract. Both individualscovered by a contract covering thejoint lives of two individuals areconsidered insured.

Who Must File Generally, every policyholder owningone or more employer-owned life


Notice and consent requirements. Toqualify as an employer-owned lifeinsurance contract, the policyholdermust meet the notice and consentrequirements listed below before theissuance of the contract. 1. Provide written notification to theemployee stating the policyholderintends to insure the employee’s lifeand the maximum face amount forwhich the employee could be insuredat the time the contract was issued.

How To File Attach Form 8925 to the policyholder’sincome tax return for each tax yearending after November 13, 2007,during which the policyholder hasemployer-owned life insurancecontract(s) in force. Recordkeeping You must keep adequate records tosupport the information reported on Form8925.

Name of Policyholder Enter the name of the policyholder(defined earlier).

2. Provide written notification to theemployee that the policyholder will bea beneficiary of any proceeds payableupon the death of the employee. 3. Receive written consent from theemployee. See Valid consent under theinstructions for line 4a.

Definitions

insurance contracts issued afterAugust 17, 2006, must file Form 8925for each tax year the contract(s) isowned. However, you are not requiredto file Form 8925 for any tax yearending before November 14, 2007.

Related person. A related person isconsidered a policyholder if thatperson is (a) related to the policyholder(defined earlier) under sections 267(b)or 707(b)(1), or (b) engaged in a tradeor business under common controlwith the policyholder. See sections52(a) and (b).

Section 1035 exchanges.Policyholders are not required tocomplete Form 8925 for a lifeinsurance contract issued after August17, 2006, as part of a section 1035exchange for a contract issued beforeAugust 18, 2006. However, any material increase in thedeath benefit or other material changeto the contract will cause it to betreated as a new contract and thepolicyholder is required to file Form8925. For master contracts undersection 264(f)(4)(E), the addition ofcovered lives is treated as a newcontract only for the additional coveredlives. See sections 1035 and 264(f)(4)(E) formore information.


Disqualified Corporate Interest Expense DisallowedUnder Section 163(j) and Related Information

OMB No. 1545-2127 8926

Form (December 2008) Department of the TreasuryInternal Revenue Service Name of corporation (name of parent, if an affiliated group)

Enter any deduction taken under section 199

Form 8926 (12-2008)


Cat. No. 37739W

1a

2a

Check here if the form is being filed on behalf of an affiliated group described in section 1504(a)

3a

1b

1f

$

2c

2b


Enter the total amount of the corporation’s money at the endof the tax year

b Enter the adjusted basis of all the corporation’s other assetsat the end of the tax year

f Debt to equity ratio. Divide line 1d by line 1e (see instructions)

g Is the corporation including as part of its assets on line 1b stock described in Regulations section1.7874-1(d) that it holds in a corporation to whom it paid disqualified interest?

b Enter any interest includible in the gross income of the corporation for the tax year

c Net interest expense. Subtract line 2b from line 2a. If zero or less, enter -0-

Enter the interest paid or accrued by the corporation for the tax year

Enter the corporation’s taxable income (loss) before the application of section 163(j)

b Enter the corporation’s net interest expense from line 2c

c Enter any net operating loss deduction taken by the corporation under section 172

1a

3a

3b

3c

d

e Enter any deduction taken for depreciation, amortization, or depletion

3d

3e

If “Yes,” enter the adjusted basis of that stock �


2a

$

i Is the corporation including as part of its assets on line 1b tangible assets it directly holds that arelocated in a foreign country? (see instructions)

If “Yes,” enter the adjusted basis of those tangible assets �

$ j Is the corporation including as part of its assets on line 1b any intangible assets?

If “Yes,” enter the adjusted basis of those intangible assets �

$ h Is the corporation including as part of its assets on line 1b stock it holds in foreign subsidiaries?

If “Yes,” enter the adjusted basis of that stock �

Enter any additional adjustments the corporation has made to its taxable income (loss) (other than those listed on lines 3b through 3e above) in arriving at its adjusted taxable income (see instructions—attach schedule)

Adjusted taxable income. Combine lines 3a through 3f. If zero or less, enter -0-

f

g

3f

3g

Yes

No

Yes

No

Yes

No

Yes

No

� Attach to the corporation’s income tax return.

1c c Add lines 1a and 1b

1d d Enter the total amount of the corporation’s indebtedness at the

end of the tax year (see instructions)

1e e Subtract line 1d from line 1c. If zero or less, enter -0-

.


Form 8926 (12-2008)

Form 8926 (12-2008)

Page 2

5a 5a

6

7 Amount of interest deduction disallowed under section 163(j) and carried forward tothe next tax year. If line 1f is 1.5 or less, enter the smaller of line 4d or line 5e. If line 1fis greater than 1.5, enter the smaller of line 4d or line 5f (see instructions)

5b

5d

5e

5f

Excess interest expense. Subtract line 4c from line 2c. If zero or less, enter -0-

b

Enter any disqualified interest paid or accrued by the corporation to a related person

d

Enter any disqualified interest paid or accrued by the corporation on indebtedness subject to a disqualified guarantee

e

Add lines 5a, 5b, and 5c

f

Enter any disqualified interest disallowed under section 163(j) for prior tax years that is treated as paid or accrued in the current tax year

Information about related persons receiving disqualified interest:

Total disqualified interest for the tax year. Add lines 5d and 5e

7

Name, Address, and ZIP code

Country of Incorporationor Organization

4a

Enter any unused excess limitation carried forward to the current tax year from the prior 3 tax years (see instructions)

Multiply line 3g by 50%

Enter any interest paid or accrued by a taxable REIT subsidiary (as defined in section 856(l))of a real estate investment trust to such trust

b

c

4a

4b

5c

4c c Add lines 4a and 4b

d 4d

a

b

c

d

e

8a 8a Unused excess limitation carryforward from the prior 2 tax

years

8b b Excess limitation for the current tax year. Subtract line 2c from

line 4a. If zero or less, enter -0-

Excess limitation carryforward to the next tax year. Add lines 8a and 8b (see instructions)

c 8c


Form




OMB No. 1545-2137



Part I

Part III


Identifying number

Tentative Credit







2 3

5

2

3

5

(a) Vehicle 1

(b) Vehicle 2

(c) Vehicle 3

Form 8936 (2010)

Cat. No. 37751E

6

6



1

1


9


7

13

14



12

13

14

7


/ /

/ /

/ /


4

4

%

%

%

Part II


8 8

11


10

10

12

9




11

10








OMB No. 1545-xxxx







5



7 Multiply line 6 by the applicable percentage:

• Tax-exempt small employers, multiply line 6 by 25% (.25)

• All other small employers, multiply line 6 by 35% (.35) . . . . . . . . . . . . . 78 If line 2 is 10 or less, enter the amount from line 7. Otherwise, see instructions . . . . . . 89 If line 3 is $25,000 or less, enter the amount from line 8. Otherwise, see instructions . . . . 9
















498



Partnership Programs

Schedule L, Balance Sheet per Books

The following lines have been added under column (b):

• Line 2a(b), “Less allowance for bad debts”• Line 5(b), “Tax-exempt securities”

Schedule M-3, Net Income (Loss) Reconciliation for Certain Partnerships

The following line has been added to Part III under “Expense/Deduction Items”:

• Line 29, “Research and development costs”

The following 2009 lines have been renumbered:

• Line 29, “Other expense/deduction items with differences” became Line 30• Line 30, “Total expense/deduction items” became Line 31


The following line has been added in Part II:

• Line 8, “Qualifying therapeutic discovery project credit”

All the lines that followed were renumbered accordingly


Line 1(b) from 2009 (Welfare to Work Credit) was removed from the form. In 2010, Line 1(b) is reserved.

The following 2009 lines have been replaced with new 2010 credits and the 2009 credits on those lines no longer exist on the 3800:

• 2009 Line 1(t), “Credits for affected Midwestern disaster area employers (Form 5884-A)” was replaced with 2010 Line 1(t), “Employer housing credit.”

• 2009 Line 1(aa), “Credit for contributions to selected community development corporations” was replaced with 2010 Line 1(aa), “New hire retention credit (Form 5884-B).”

Credits on Lines 1c, 1g, 1l, 1p, 1t, 1u, 1w expired in 2009 and currently apply in 2010 only to mem-bers of certain fiscal year 2009–2010 pass-through entities. The Partnership Study will still include them in the field.

Form 5884-B, New Hire Retention Credit

Lines 10–13 will be edited for Tax Year 2010.

499



Partnership Programs—continued

Form 6765, Credit for Increasing Research Activities

This credit now applies in 2010 only to members of certain fiscal year 2009–2010 pass-through enti-ties (including Partnerships). The Partnership Study will still include them when filed.

Form 8825, Rental Real Estate Income and Expenses of a Partnership or an S Corporation

The following line has been added:

• Line 17, “Income or (Loss) from each property. Subtract Line 16 from line 2.”

The following lines have been renumbered as accordingly:

• 2009 Line 17 is now 2010 Line 18a• 2009 Line 18 is now 2010 Line 18b

Form 8845, Indian Employment Credit

This credit now applies in 2010 only to members of certain fiscal year 2009–2010 pass-through enti-ties (including Partnerships). The Partnership Study will still include them when filed.


This form was redesigned for 2010 to include a separate column (a) for “Oil-related production activities”

Line 13, there was a percentage change from 6% in 2009 to 9% for 2010.

The following lines have been added but we only plan to include new Lines 10(a) and 14(a):

• Line 1(a), “Domestic production gross receipts (DPGR)” for Oil-related production activities• Line 2(a), “Allocable cost of goods sold” for Oil-related production activities• Line 3(a), “Enter deductions and losses allocable to DPGR” for Oil-related production activities• Line 4(a), “…enter the amount of cost of goods sold and other deductions or losses you ratably

apportion to DPGR” for Oil-related production activities• Line 5(a), “Add lines 2 through 4” for Oil-related production activities• Line 6(a), “Subtract line 5 from line 1” for Oil-related production activities• Line 7(a), “Qualified production activities income from estates, trusts, and certain partnerships

and S corporations” for Oil-related production activities• Line 8(a), “Add lines 6 and 7” for Oil-related production activities• Line 9(a), “Amount allocated to beneficiaries of the estate or trust” of Oil-related production

activities

500



Partnership Programs—continued

Form 8903, Domestic Production Activities Deduction—continued

• Line 10(a), “Oil-related qualified production activities income” for Oil-related production ac-tivities

• Line 14(a), “Enter the smaller of line 10a or line 12” for Oil-related production activities• Line 14(b), ”Reduction for oil-related qualified production activities income. Multiply like 14a

by 3%”• Line 15, “Subtract line 14b from line 13”

The following 2009 lines have been renumbered:

• Line 10, ”Qualified production activities income” became 2010 Line 10(b)• Line 14–Line 23 became 2010 Line 16–Line 25 respectively

Form 8910, Alternative Motor Vehicle Credit

The following lines have been added:

• Lines 1 through 3 for up to 3 vehicles which include:• Line 1, “Year, make, and model of vehicle”• Line 2, “Enter date vehicle was placed in service”• Line 3, “Credit allowable”

Form 8911, Alternative Fuel Vehicle Refueling Property Credit

The following lines have been added:

• Line 1, “Total cost of qualified alternative fuel vehicle refueling property placed in service”• Line 2, “Business/investment use part”• Line 3, “Section 179 expense deduction”• Line 7, “Maximum business/investment use part of credit”

We will edit Lines 1, 2, 3, and 7 columns (a) and (b) for TY2010


This is a new form for the 2010 Partnership Study. See detail on attached form.

Lines 1 through 16 will be edited for TY2010.

502 Partnership Programs


U.S. Return of Partnership Income For calendar year 2010, or tax year beginning , 2010, ending , 20 .


OMB No. 1545-0099

2010Use the

IRS label. Other- wise, print

or type.

Name of partnership

Number, street, and room or suite no. If a P.O. box, see the instructions.


A Principal business activity

B Principal product or service

C Business code number


E Date bus ss started

F Total assets (see the instructions)

$

G Check applicable boxes: (1) Initial return (2) Final return (3) Name change (4) Address change (5) Amended return

(6) Technical termination - also check (1) or (2)

H Check accounting method: (1) Cash (2) Accrual (3) Other (specify)

I Number of Schedules K-1. Attach one for each person who was a partner at any time during the tax year

J Check if Schedules C and M-3 are attached . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Caution. Include only trade or business income and expenses on lines 1a through 22 below. See the instructions for more information.

Inco

me

1a Gross receipts or sales . . . . . . . . . . . . 1a b Less returns and allowances . . . . . . . . . . . 1b 1c

2 Cost of goods sold (Schedule A, line 8) . . . . . . . . . . . . . . . . . 2 3 Gross profit. Subtract line 2 from line 1c . . . . . . . . . . . . . . . . . 3 4 Ordinary income (loss) from other partnerships, estates, and trusts (attach statement) . . 4 5 Net farm profit (loss) (attach Schedule F (Form 1040)) . . . . . . . . . . . . 5 6 Net gain (loss) from Form 4797, Part II, line 17 (attach Form 4797) . . . . . . . . 6 7 Other income (loss) (attach statement) . . . . . . . . . . . . . . . . . 7 8 Total income (loss). Combine lines 3 through 7 . . . . . . . . . . . . . . 8

Ded

ucti

ons

(s

ee t

he in

stru

ctio

ns fo

r lim

itatio

ns) 9 Salaries and wages (other than to partners) (less employment credits) . . . . . . . 9

10 Guaranteed payments to partners . . . . . . . . . . . . . . . . . . . 10 11 Repairs and maintenance . . . . . . . . . . . . . . . . . . . . . . 11 12 Bad debts . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 13 Rent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 Taxes and licenses . . . . . . . . . . . . . . . . . . . . . . . . 14 15 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 16a Depreciation (if required, attach Form 4562) . . . . . . 16a

b Less depreciation reported on Schedule A and elsewhere on return 16b 16c 17 Depletion (Do not deduct oil and gas depletion.) . . . . . . . . . . . . . 17 18 Retirement plans, etc. . . . . . . . . . . . . . . . . . . . . . . . 18 19 Employee benefit programs . . . . . . . . . . . . . . . . . . . . . 19 20 Other deductions (attach statement) . . . . . . . . . . . . . . . . . . 20 21 Total deductions. Add the amounts shown in the far right column for lines 9 through 20 . 21 22 Ordinary business income (loss). Subtract line 21 from line 8 . . . . . . . . . 22

Sign Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than general partner or limited liability company member manager) is based on all information of which preparer has any knowledge.


Signature of general partner or limited liability company member manager Date


Print/Type preparer’s name Preparer’s signature Date Check if self- employed

PTIN

Firm’s name ▶Firm’s address ▶

Firm's EIN

Phone no.

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 11390Z Form 1065 (2010)

3.5% Gross Income Tax for PTP

503Partnership Programs

Form 1065 (2010) Page 2 Schedule A Cost of Goods Sold (see the instructions) 1 Inventory at beginning of year . . . . . . . . . . . . . . . . . . . . . . . 1 2 Purchases less cost of items withdrawn for personal use . . . . . . . . . . . . . . 2 3 Cost of labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Additional section 263A costs (attach statement) . . . . . . . . . . . . . . . . . 4 5 Other costs (attach statement) . . . . . . . . . . . . . . . . . . . . . . 5 6 Total. Add lines 1 through 5 . . . . . . . . . . . . . . . . . . . . . . . 6 7 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . 7 8 Cost of goods sold. Subtract line 7 from line 6. Enter here and on page 1, line 2 . . . . . . . 8 9 a Check all methods used for valuing closing inventory:

(i) Cost as described in Regulations section 1.471-3 (ii) Lower of cost or market as described in Regulations section 1.471-4 (iii) Other (specify method used and attach explanation)

b Check this box if there was a writedown of “subnormal” goods as described in Regulations section 1.471-2(c) . . . c Check this box if the LIFO inventory method was adopted this tax year for any goods (if checked, attach Form 970) . . d Do the rules of section 263A (for property produced or acquired for resale) apply to the partnership? . . . . Yes Noe Was there any change in determining quantities, cost, or valuations between opening and closing inventory? . . Yes No

If “Yes,” attach explanation.

Schedule B Other Information 1 What type of entity is filing this return? Check the applicable box: Yes No

a Domestic general partnership b Domestic limited partnership c Domestic limited liability company d Domestic limited liability partnership e Foreign partnership f Other

2 At any time during the tax year, was any partner in the partnership a disregarded entity, a partnership (including an entity treated as a partnership), a trust, an S corporation, an estate (other than an estate of a deceased partner), or a nominee or similar person? . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 At the end of the tax year:

a Did any foreign or domestic corporation, partnership (including any entity treated as a partnership), trust, or tax-exempt organization own, directly or indirectly, an interest of 50% or more in the profit, loss, or capital of thepartnership? For rules of constructive ownership, see instructions. If “Yes,” attach Schedule B-1, Information onPartners Owning 50% or More of the Partnership . . . . . . . . . . . . . . . . . . . . .

b Did any individual or estate own, directly or indirectly, an interest of 50% or more in the profit, loss, or capital ofthe partnership? For rules of constructive ownership, see instructions. If “Yes,” attach Schedule B-1, Informationon Partners Owning 50% or More of the Partnership . . . . . . . . . . . . . . . . . . . .

4 At the end of the tax year, did the partnership: a Own directly 20% or more, or own, directly or indirectly, 50% or more of the total voting power of all classes of

stock entitled to vote of any foreign or domestic corporation? For rules of constructive ownership, see instructions. If “Yes,” complete (i) through (iv) below . . . . . . . . . . . . . . . . . . . . .

(i) Name of Corporation (ii) Employer Identification Number (if any)

(iii) Country of Incorporation

(iv) Percentage Owned in Voting Stock

b Own directly an interest of 20% or more, or own, directly or indirectly, an interest of 50% or more in the profit, loss, or capital in any foreign or domestic partnership (including an entity treated as a partnership) or in the beneficial interest of a trust? For rules of constructive ownership, see instructions. If “Yes,” complete (i) through (v) below . .

(i) Name of Entity (ii) Employer Identification

Number (if any)

(iii) Type of Entity

(iv) Country of Organization

(v) Maximum Percentage Owned in Profit, Loss, or Capital

Form 1065 (2010)

Type of Entity


Form 1065 (2010) Page 3 Yes No

5 Did the partnership file Form 8893, Election of Partnership Level Tax Treatment, or an election statement under section 6231(a)(1)(B)(ii) for partnership-level tax treatment, that is in effect for this tax year? See Form 8893 for more details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 Does the partnership satisfy all four of the following conditions? a The partnership’s total receipts for the tax year were less than $250,000.b The partnership’s total assets at the end of the tax year were less than $1 million.c Schedules K-1 are filed with the return and furnished to the partners on or before the due date (including

extensions) for the partnership return.

d The partnership is not filing and is not required to file Schedule M-3 . . . . . . . . . . . . . . .If “Yes,” the partnership is not required to complete Schedules L, M-1, and M-2; Item F on page 1 of Form 1065; or Item L on Schedule K-1.

7 Is this partnership a publicly traded partnership as defined in section 469(k)(2)? . . . . . . . . . . . .

8 During the tax year, did the partnership have any debt that was cancelled, was forgiven, or had the terms modified so as to reduce the principal amount of the debt? . . . . . . . . . . . . . . . . . .

9 Has this partnership filed, or is it required to file, Form 8918, Material Advisor Disclosure Statement, to provide information on any reportable transaction? . . . . . . . . . . . . . . . . . . . . . . . .

10 At any time during calendar year 2010, did the partnership have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)? See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts. If “Yes,” enter the name of the foreign country.

11 At any time during the tax year, did the partnership receive a distribution from, or was it the grantor of, or transferor to, a foreign trust? If “Yes,” the partnership may have to file Form 3520, Annual Return To Report Transactions With Foreign Trusts and Receipt of Certain Foreign Gifts. See instructions . . . . . . . . .

12a Is the partnership making, or had it previously made (and not revoked), a section 754 election? . . . . . .See instructions for details regarding a section 754 election.

b Did the partnership make for this tax year an optional basis adjustment under section 743(b) or 734(b)? If “Yes,” attach a statement showing the computation and allocation of the basis adjustment. See instructions . . . .

c Is the partnership required to adjust the basis of partnership assets under section 743(b) or 734(b) because of a substantial built-in loss (as defined under section 743(d)) or substantial basis reduction (as defined under section 734(d))? If “Yes,” attach a statement showing the computation and allocation of the basis adjustment. See instructions.

13 Check this box if, during the current or prior tax year, the partnership distributed any property received in a like-kind exchange or contributed such property to another entity (other than entities wholly-owned by the partnership throughout the tax year) . . . . . . . . . . . . . . . . . . . . . . . .

14 At any time during the tax year, did the partnership distribute to any partner a tenancy-in-common or other undivided interest in partnership property? . . . . . . . . . . . . . . . . . . . . . . . .

15 If the partnership is required to file Form 8858, Information Return of U.S. Persons With Respect To Foreign Disregarded Entities, enter the number of Forms 8858 attached. See instructions

16 Does the partnership have any foreign partners? If “Yes,” enter the number of Forms 8805, Foreign Partner’s Information Statement of Section 1446 Withholding Tax, filed for this partnership.

17 Enter the number of Forms 8865, Return of U.S. Persons With Respect to Certain Foreign Partnerships, attached to this return.

Designation of Tax Matters Partner (see instructions) Enter below the general partner designated as the tax matters partner (TMP) for the tax year of this return:

Name of designated TMP

Identifying number of TMP

If the TMP is an entity, name of TMP representative

Phone number of TMP

Address of designated TMP

Form 1065 (2010)


Form 1065 (2010) Page 4 Schedule K Partners’ Distributive Share Items Total amount

Inco

me

(Lo

ss)

1 Ordinary business income (loss) (page 1, line 22) . . . . . . . . . . . . . 12 Net rental real estate income (loss) (attach Form 8825) . . . . . . . . . . . 2 3a Other gross rental income (loss) . . . . . . . . 3a b Expenses from other rental activities (attach statement) . 3b c Other net rental income (loss). Subtract line 3b from line 3a . . . . . . . . . 3c

4 Guaranteed payments . . . . . . . . . . . . . . . . . . . . . 4 5 Interest income . . . . . . . . . . . . . . . . . . . . . . . . 5 6 Dividends: a Ordinary dividends . . . . . . . . . . . . . . . . . 6a

b Qualified dividends . . . . . . 6b 7 Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 Net short-term capital gain (loss) (attach Schedule D (Form 1065)) . . . . . . . 8 9 a Net long-term capital gain (loss) (attach Schedule D (Form 1065)) . . . . . . . 9a b Collectibles (28%) gain (loss) . . . . . . . . . 9b c Unrecaptured section 1250 gain (attach statement) . . 9c

10 Net section 1231 gain (loss) (attach Form 4797) . . . . . . . . . . . . . 10 11 Other income (loss) (see instructions) Type 11

Ded

ucti

ons

12 Section 179 deduction (attach Form 4562) . . . . . . . . . . . . . . . 12 13a Contributions . . . . . . . . . . . . . . . . . . . . . . . . 13a

b Investment interest expense . . . . . . . . . . . . . . . . . . . 13b c Section 59(e)(2) expenditures: (1) Type (2) Amount 13c(2)

d Other deductions (see instructions) Type 13d

Sel

f-

Empl

oy-

men

t

14a Net earnings (loss) from self-employment . . . . . . . . . . . . . . . 14a b Gross farming or fishing income . . . . . . . . . . . . . . . . . . 14b c Gross nonfarm income . . . . . . . . . . . . . . . . . . . . . 14c

Cre

dit

s

15a Low-income housing credit (section 42(j)(5)) . . . . . . . . . . . . . . 15a b Low-income housing credit (other) . . . . . . . . . . . . . . . . . 15b c Qualified rehabilitation expenditures (rental real estate) (attach Form 3468) . . . . 15c d Other rental real estate credits (see instructions) Type 15d e Other rental credits (see instructions) Type 15e f Other credits (see instructions) Type 15f

Fore

ign

Tra

nsac

tio

ns

16a Name of country or U.S. possession b Gross income from all sources . . . . . . . . . . . . . . . . . . . 16b c Gross income sourced at partner level . . . . . . . . . . . . . . . . 16c

Foreign gross income sourced at partnership level d Passive category e General category f Other 16f

Deductions allocated and apportioned at partner level g Interest expense h Other . . . . . . . . . . 16h

Deductions allocated and apportioned at partnership level to foreign source income i Passive category j General category k Other 16k l Total foreign taxes (check one): Paid Accrued . . . . . . . . 16l m Reduction in taxes available for credit (attach statement) . . . . . . . . . . 16m n Other foreign tax information (attach statement) . . . . . . . . . . . . .

Alt

erna

tive

M

inim

um T

ax

(AM

T) I

tem

s

17a Post-1986 depreciation adjustment . . . . . . . . . . . . . . . . . 17a b Adjusted gain or loss . . . . . . . . . . . . . . . . . . . . . . 17b c Depletion (other than oil and gas) . . . . . . . . . . . . . . . . . . 17c d Oil, gas, and geothermal properties—gross income . . . . . . . . . . . . 17d e Oil, gas, and geothermal properties—deductions . . . . . . . . . . . . . 17e f Other AMT items (attach statement) . . . . . . . . . . . . . . . . . 17f

Oth

er In

form

atio

n 18a Tax-exempt interest income . . . . . . . . . . . . . . . . . . . . 18a b Other tax-exempt income . . . . . . . . . . . . . . . . . . . . 18b c Nondeductible expenses . . . . . . . . . . . . . . . . . . . . . 18c

19a Distributions of cash and marketable securities . . . . . . . . . . . . . 19a b Distributions of other property . . . . . . . . . . . . . . . . . . . 19b

20a Investment income . . . . . . . . . . . . . . . . . . . . . . . 20a b Investment expenses . . . . . . . . . . . . . . . . . . . . . . 20b c Other items and amounts (attach statement) . . . . . . . . . . . . . .

Form 1065 (2010)


Form 1065 (2010) Page 5 Analysis of Net Income (Loss)

1 Net income (loss). Combine Schedule K, lines 1 through 11. From the result, subtract the sum of Schedule K, lines 12 through 13d, and 16l . . . . . . . . . . . . . . . . . . 1

2 Analysis by partner type:

(i) Corporate (ii) Individual

(active) (iii) Individual

(passive) (iv) Partnership

(v) Exempt organization

(vi) Nominee/Other

a General partners b Limited partners

Schedule L Balance Sheets per Books Beginning of tax year End of tax year


1 Cash . . . . . . . . . . . . .2a Trade notes and accounts receivable . . .b Less allowance for bad debts . . . . .

3 Inventories . . . . . . . . . . .4 U.S. government obligations . . . . .5 Tax-exempt securities . . . . . . .6 Other current assets (attach statement) . .7 Mortgage and real estate loans . . . .8 Other investments (attach statement) . . .9a Buildings and other depreciable assets . .b Less accumulated depreciation . . . .

10a Depletable assets . . . . . . . . .b Less accumulated depletion . . . . .

11 Land (net of any amortization) . . . . .12a Intangible assets (amortizable only) . . .

b Less accumulated amortization . . . .13 Other assets (attach statement) . . . .14 Total assets . . . . . . . . . . .

Liabilities and Capital 15 Accounts payable . . . . . . . . .16 Mortgages, notes, bonds payable in less than 1 year

17 Other current liabilities (attach statement) .18 All nonrecourse loans . . . . . . . .19 Mortgages, notes, bonds payable in 1 year or more 20 Other liabilities (attach statement) . . . .21 Partners’ capital accounts . . . . . .22 Total liabilities and capital . . . . . .Schedule M-1 Reconciliation of Income (Loss) per Books With Income (Loss) per Return

Note. Schedule M-3 may be required instead of Schedule M-1 (see instructions). 1 Net income (loss) per books . . . .

2

Income included on Schedule K, lines 1, 2, 3c,5, 6a, 7, 8, 9a, 10, and 11, not recorded onbooks this year (itemize):

3 Guaranteed payments (other than health insurance) . . . . . . .

4

Expenses recorded on books this year not included on Schedule K, lines 1 through 13d, and 16l (itemize):

a Depreciation $ b Travel and entertainment $


6

Income recorded on books this year not included on Schedule K, lines 1 through 11 (itemize):


7

Deductions included on Schedule K, lines 1 through 13d, and 16l, not charged against book income this year (itemize):

a Depreciation $

8 Add lines 6 and 7 . . . . . . . .9 Income (loss) (Analysis of Net Income

(Loss), line 1). Subtract line 8 from line 5 .

Schedule M-2 Analysis of Partners’ Capital Accounts 1 Balance at beginning of year . . .2 Capital contributed: a Cash . . .

b Property . .3 Net income (loss) per books . . . . 4 Other increases (itemize):


6 Distributions: a Cash . . . . . .b Property . . . . .


8 Add lines 6 and 7 . . . . . . . .9 Balance at end of year. Subtract line 8 from line 5

Form 1065 (2010)

NEW

NEW




Capital Gains and Losses Attach to Form 1065. See separate instructions.

Use Schedule D-1 to list additional transactions for lines 1 and 7.

OMB No. 1545-0099

2010Name of partnership Employer identification number

Part I Short-Term Capital Gains and Losses—Assets Held One Year or Less (a) Description of property

(Example: 100 shares of “Z” Co.)

(b) Date acquired (month, day, year)

(c) Date sold (month, day, year)


(e) Cost or other basis (see instructions)


1

2 Enter short-term capital gain or (loss), if any, from Schedule D-1, line 2 . . . . . . . 2

3 Short-term capital gain from installment sales from Form 6252, line 26 or 37 . . . . . . 3

4 Short-term capital gain (loss) from like-kind exchanges from Form 8824 . . . . . . . 4

5 Partnership’s share of net short-term capital gain (loss), including specially allocated short-term capital gains (losses), from other partnerships, estates, and trusts . . . . . . . 5

6 Net short-term capital gain or (loss). Combine lines 1 through 5 in column (f). Enter here and on Form 1065, Schedule K, line 8 or 11 . . . . . . . . . . . . . . . . . . 6

Part II Long-Term Capital Gains and Losses—Assets Held More Than One Year (a) Description of property

(Example: 100 shares of “Z” Co.)






7

8 Enter long-term gain or (loss), if any, from Schedule D-1, line 8 . . . . . . . . . . 8

9 Long-term capital gain from installment sales from Form 6252, line 26 or 37 . . . . . . 9

10 Long-term capital gain (loss) from like-kind exchanges from Form 8824 . . . . . . . 10

11 Partnership’s share of net long-term capital gain (loss), including specially allocated long-termcapital gains (losses), from other partnerships, estates, and trusts . . . . . . . . . 11

12 Capital gain distributions . . . . . . . . . . . . . . . . . . . . . . . 12

13 Net long-term capital gain or (loss). Combine lines 7 through 12 in column (f). Enter here and on Form 1065, Schedule K, line 9a or 11 . . . . . . . . . . . . . . . . 13

For Paperwork Reduction Act Notice, see the Instructions for Form 1065. Cat. No. 11393G Schedule D (Form 1065) 2010

SOCA Code

SOCA Code


Form 1065-BDepartment of the Treasury Internal Revenue Service

U.S. Return of Income for Electing Large Partnerships

For calendar year 2010, or tax year beginning , 2010, and ending , 20 . See separate instructions.

OMB No. 1545-1626

2010A Principal business activity

B Principal product or service

C Business code no. (see instructions)

Use the IRS label. Other- wise, print or type.

Name of partnership




E Date business started

F Total assets (see instructions)

$

G Check applicable boxes: (1) Final return (2) Name change (3) Address change (4) Amended return

H Check accounting method: (1) Cash (2) Accrual (3) Other (specify)

I Number of Schedules K-1. Attach one for each person who was a partner at any time during the tax year

J Check if Schedule M-3 (Form 1065) is attached . . . . . . . . . . . . . . . .

Part I Taxable Income or Loss From Passive Loss Limitation Activities

Inco

me

1a Gross receipts or sales b Less returns and allowances c Bal 1c 2 Cost of goods sold (Schedule A, line 8) . . . . . . . . . . . . . . . . . . . 2 3 Gross profit. Subtract line 2 from line 1c . . . . . . . . . . . . . . . . . . 3 4 Net rental real estate income (loss) (attach Form 8825) . . . . . . . . . . . . . . 4 5 Net income (loss) from other rental activities (attach schedule) . . . . . . . . . . . 5 6 Ordinary income (loss) from other partnerships, estates, and trusts (attach schedule) . . . . 6 7 Net farm profit (loss) (attach Schedule F (Form 1040)) . . . . . . . . . . . . . . 7 8 Excess of net short-term capital gain over net long-term capital loss (Schedule D, line 16) . . 8 9 Net gain (loss) from Form 4797, Part II, line 17 (attach Form 4797) . . . . . . . . . . 9

10 Other income (loss) (see instructions) (attach schedule) . . . . . . . . . . . . . 10 11 Total income (loss). Combine lines 3 through 10 . . . . . . . . . . . . . . . 11

Ded

ucti

ons

12 Salaries and wages (other than to partners) (less employment credits) . . . . . . . . . 12 13 Guaranteed payments to partners . . . . . . . . . . . . . . . . . . . . 13 14 Repairs and maintenance . . . . . . . . . . . . . . . . . . . . . . . 14 15 Bad debts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 16 Rent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 17 Taxes and licenses . . . . . . . . . . . . . . . . . . . . . . . . . 17 18 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 19a Depreciation and section 179 expense deduction (see instructions) 19a

b Less: depreciation reported on Schedule A and elsewhere on return 19b 19c20 Depletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 21 Retirement plans, etc. . . . . . . . . . . . . . . . . . . . . . . . . 21 22 Employee benefit programs . . . . . . . . . . . . . . . . . . . . . . 22 23 Other deductions (attach schedule) . . . . . . . . . . . . . . . . . . . . 23 24 Total deductions. Add the amounts shown in the far right column for lines 12 through 23 . . 24

25 Taxable income (loss) from passive loss limitation activities. Subtract line 24 from line 11 . 25

Tax

an

d

Pay

men

ts 26 Tax (see instructions). Check if from: a Form 4255 b Form 8611 . . . . . . 26 27 Other payments. Check if from: a Form 2439 b Form 4136 . . . . . . 27 28 Amount owed. Enter the excess of line 26 over line 27 . . . . . . . . . . . . . . 28 29 Overpayment. Enter the excess of line 27 over line 26 . . . . . . . . . . . . . . 29

Sign Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than general partner or limited liability company member manager) is based on all information of which preparer has any knowledge.

Signature of general partner or limited liability company member manager Date




PTIN



For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 26265H Form 1065-B (2010)

3.5% Gross Income Tax for PTP

Section 179

Oil & Gas Depletion


Form 1065-B (2010) Page 2 Part II Taxable Income or Loss From Other Activities

1 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 a Total ordinary dividends . . . . . . . . . . . . . . . . 2a

b Qualified dividends . . . . . . . . . . . . . . . . . 2bc Nonqualified dividends (subtract line 2b from 2a) . . . . . . . . . . . . . . . . . 2c

3 Gross royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Excess of net short-term capital gain over net long-term capital loss (Schedule D, line 19) . . . 4 5 Other income (loss) (see instructions) (attach schedule) . . . . . . . . . . . . . . . 5 6 Total income (loss). Add lines 1, 2c, 3, 4, and 5 . . . . . . . . . . . . . . . . . 6 7 Interest expense on investment debts (attach Form 4952) . . . . . . . . . . . . . . 7 8 State and local income taxes (see instructions) . . . . . . . . . . . . . . . . . 8 9 Charitable contributions (see instructions for limitations and required attachment) . . . . . . 9

10a Total miscellaneous itemized deductions . . . . . . . . . . 10ab Deductible amount. Multiply line 10a by 30% . . . . . . . . . . . . . . . . . . 10b

11 Other deductions (attach schedule) . . . . . . . . . . . . . . . . . . . . . 11 12 Total deductions. Add lines 7, 8, 9, 10b, and 11 . . . . . . . . . . . . . . . . . 12 13 Taxable income (loss) from other activities. Subtract line 12 from line 6 . . . . . . . . 13 Schedule A Cost of Goods Sold (see instructions)1 Inventory at beginning of year . . . . . . . . . . . . . . . . . . . . . . . 1 2 Purchases less cost of items withdrawn for personal use . . . . . . . . . . . . . . 2 3 Cost of labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Additional section 263A costs (attach schedule) . . . . . . . . . . . . . . . . . 4 5 Other costs (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . 5 6 Total. Add lines 1 through 5 . . . . . . . . . . . . . . . . . . . . . . . . 6 7 Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . . 7 8 Cost of goods sold. Subtract line 7 from line 6. Enter here and on page 1, line 2 . . . . . . 8 9 a Check all methods used for valuing closing inventory:

(i) Cost as described in Regulations section 1.471-3(ii) Lower of cost or market as described in Regulations section 1.471-4(iii) Other (specify method used and attach explanation)

b Check this box if there was a writedown of “subnormal” goods as described in Regulations section 1.471-2(c) . .

c Check this box if the LIFO inventory method was adopted this tax year for any goods (if checked, attach Form 970) .

d Do the rules of section 263A (for property produced or acquired for resale) apply to the partnership? . . Yes Noe Was there any change in determining quantities, cost, or valuations between opening and closing inventory?

If “Yes,” attach explanation.Yes No

Schedule B Other Information (see instructions)1 What type of entity is filing this return? Check the applicable box:

a Domestic general partnership b Domestic limited partnershipc Domestic limited liability company d Domestic limited liability partnershipe Foreign partnership f Other

Yes No

2 Are any partners in this partnership also partnerships? . . . . . . . . . . . . . . . . . . . .

3 During the partnership’s tax year, did the partnership own any interest in another partnership or in any foreign entity that was disregarded as an entity separate from its owner under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” see instructions for required attachment . . . . . . . . . . . . . . . . .

4 Does this partnership have any foreign partners? If “Yes,” the partnership may have to file Forms 8804, 8805, and 8813. (See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 Is this partnership a publicly traded partnership as defined in section 469(k)(2)? . . . . . . . . . . . .6 Has this partnership filed, or is it required to file, Form 8918, Material Advisor Disclosure Statement, to provide

information on any reportable transaction? . . . . . . . . . . . . . . . . . . . . . . . .

7 At any time during calendar year 2010, did the partnership have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)? See instructions for exceptions and filing requirements for Form TD F 90-22.1. If “Yes,” enter the name of the foreign country.

8 During the tax year, did the partnership receive a distribution from, or was it the grantor to, or transferor to, a foreign trust? If “Yes,” the partnership may have to file Form 3520 . . . . . . . . . . . . . . . .

9 Enter the number of Forms 8865, Return of U.S. Persons With Respect to Certain Foreign Partnerships, attached to this return.

Form 1065-B (2010)

Type of Entity


Form 1065-B (2010) Page 3 Schedule D Capital Gains and Losses (Use Schedule D-1 (Form 1065) to list additional transactions for

lines 1 and 6)Part I—Short-Term Capital Gains and Losses—Assets Held 1 Year or Less

(a) Description of property (e.g., 100 shares

of “Z” Co.)






1

2 Enter short-term gain or (loss), if any, from Schedule D-1 (Form 1065), line 2 . . . . . . . . . 23 Short-term capital gain from installment sales from Form 6252, line 26 or 37 . . . . . . . . . 34 Short-term capital gain (loss) from like-kind exchanges from Form 8824 . . . . . . . . . . 45 Net short-term capital gain or (loss). Combine lines 1 through 4 in column (f) . . . . . . . . 5

Part II—Long-Term Capital Gains and Losses—Assets Held More Than 1 Year(a) Description of property

(e.g., 100 shares of “Z” Co.)






6

7 Enter long-term gain or (loss), if any, from Schedule D-1 (Form 1065), line 8 . . . . . . . . . 78 Enter gain from Form 4797, Part I . . . . . . . . . . . . . . . . . . . . . . . 89 Long-term capital gain from installment sales from Form 6252, line 26 or 37 . . . . . . . . . 9

10 Long-term capital gain (loss) from like-kind exchanges from Form 8824 . . . . . . . . . . 1011 Net long-term capital gain or (loss). Combine lines 6 through 10 in column (f) . . . . . . . . 11

Part III—Summary of Parts I and II12 Combine lines 5 and 11 and enter the net gain (loss) . . . . . . . . . . . . . . . 1213 Enter excess of net short-term capital gain (line 5) over net long-term capital loss (line 11) . . . 1314 Net capital gain or (loss). Subtract line 13 from line 12 . . . . . . . . . . . . . . 14

Part IV—Net Capital Gain (Loss) From Passive Loss Limitation Activities15 Redetermine the amount on line 13 by taking into account only gains and losses from passive loss

limitation activities . . . . . . . . . . . . . . . . . . . . . . . . . . . 1516 Excess of net short-term capital gain over net long-term capital loss. Enter the smaller of the

amount on line 13 or line 15. Enter here and on page 1, Part I, line 8 . . . . . . . . . . 1617 Redetermine the amount on line 14 by taking into account only gains and losses from passive loss

limitation activities . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

18 Net capital gain or (loss) from passive loss limitation activities. If lines 14 and 17 are bothpositive or both negative, enter the smaller of line 14 or line 17. Otherwise, enter -0-. Enter here and on Schedule K, line 4a . . . . . . . . . . . . . . . . . . . . . . . . 18Note. When figuring whether line 14 or line 17 is smaller, treat both numbers as positive.

Part V—Net Capital Gain (Loss) From Other Activities19 Excess of net short-term capital gain over net long-term capital loss. Subtract line 16 from

line 13. Enter here and on page 2, Part II, line 4 . . . . . . . . . . . . . . . . . 1920 Net capital gain or (loss) from other activities. Subtract line 18 from line 14. Enter here and on

Schedule K, line 4b . . . . . . . . . . . . . . . . . . . . . . . . . . 20Form 1065-B (2010)

SOCA Code

SOCA Code


Form 1065-B (2010) Page 4 Schedule K Partners’ Shares of Income, Credits, Deductions, etc.

(a) Distributive share items (b) Total amount1a Taxable income (loss) from passive loss limitation activities (Part I, line 25) . . . . . . . . 1ab Amount on line 1a allocated to general partners as:

(1) Taxable income (loss) from trade or business activities . . . . . 1b(1)(2) Taxable income (loss) from rental real estate activities . . . . . 1b(2)(3) Taxable income (loss) from other rental activities . . . . . . . 1b(3)

c Total amount on line 1a allocated to general partners. Combine lines 1b(1) through 1b(3) . . . 1cd Taxable income (loss) from passive loss limitation activities allocated to limited partners. Subtract

line 1c from line 1a (report on Schedules K-1, box 1) . . . . . . . . . . . . . . . 1d2 Taxable income (loss) from other activities (Part II, line 13) . . . . . . . . . . . . . . 23 Qualified dividends from other activities (Part II, line 2b) . . . . . . . . . . . . . . 34 Net capital gain (loss) from passive loss limitation activities (Schedule D, line 18) . . . . . . 4aa

b Net capital gain (loss) from other activities (Schedule D, line 20) . . . . . . . . . . . . 4b5 Net passive alternative minimum tax adjustment . . . . . . . . . . . . . . . . . 56 Net other alternative minimum tax adjustment . . . . . . . . . . . . . . . . . . 67 Guaranteed payments . . . . . . . . . . . . . . . . . . . . . . . . . 78 Income from discharge of indebtedness . . . . . . . . . . . . . . . . . . . . 89 Tax-exempt interest income . . . . . . . . . . . . . . . . . . . . . . . . 9

10 General credits (see instructions) . . . . . . . . . . . . . . . . . . . . . . 1011 Low-income housing credit (see instructions) . . . . . . . . . . . . . . . . . . 1112 Rehabilitation credit from rental real estate activities (attach Form 3468) . . . . . . . . . 1213a Net earnings (loss) from self-employment . . . . . . . . . . . . . . . . . . . 13a

b Gross nonfarm income . . . . . . . . . . . . . . . . . . . . . . . . . 13b14a Name of foreign country or U.S. possession

b Gross income from all sources . . . . . . . . . . . . . . . . . . . . . . . 14bc Gross income sourced at partner level (attach schedule) . . . . . . . . . . . . . . 14cd Foreign gross income sourced at partnership level:

(1) Passive category . . . . . . . . . . . . . . . . . . . . . . . . . . 14d(1)(2) General category . . . . . . . . . . . . . . . . . . . . . . . . . . 14d(2)(3) Other (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . 14d(3)

e Deductions allocated and apportioned at partner level:(1) Interest expense . . . . . . . . . . . . . . . . . . . . . . . . . . 14e(1)(2) Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14e(2)

f Deductions allocated and apportioned at partnership level to foreign source income:(1) Passive category . . . . . . . . . . . . . . . . . . . . . . . . . . 14f(1)(2) General category . . . . . . . . . . . . . . . . . . . . . . . . . . 14f(2)(3) Other (attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . 14f(3)

g Total foreign taxes (check one): Paid Accrued 14gh Reduction in taxes available for credit (attach schedule) . . . . . . . . . . . . . . 14h

15 Other items and amounts required to be reported separately to partners (attach schedule)Analysis of Net Income (Loss)

1 Net income (loss). In column (b), add lines 1c through 4b, 7, and 8. From the result, subtract line 14g 1

2Analysis by partner type:

(i) Corporate(ii) Individual

(active)(iii) Individual

(passive)(iv) Partnership

(v) Exempt organization

(vi) Nominee/Other

a General partnersb Limited partners

Form 1065-B (2010)


Form 1065-B (2010) Page 5 Schedule L Balance Sheets per Books

Beginning of tax year End of tax year


1 Cash . . . . . . . . . . . . . .2a Trade notes and accounts receivable . . . .b Less allowance for bad debts . . . . . .

3 Inventories . . . . . . . . . . . .4 U.S. government obligations . . . . . .5 Tax-exempt securities . . . . . . . .6 Other current assets (attach schedule) . . .7 Mortgage and real estate loans . . . . .8 Other investments (attach schedule) . . . .9a Buildings and other depreciable assets . . .b Less accumulated depreciation . . . . .

10a Depletable assets . . . . . . . . . .b Less accumulated depletion . . . . . .

11 Land (net of any amortization) . . . . . .12a Intangible assets (amortizable only) . . . .

b Less accumulated amortization . . . . .13 Other assets (attach schedule) . . . . . .14 Total assets . . . . . . . . . . . .

Liabilities and Capital15 Accounts payable . . . . . . . . . .16 Mortgages, notes, bonds payable in less than 1 year17 Other current liabilities (attach schedule) . .18 All nonrecourse loans . . . . . . . . .19 Mortgages, notes, bonds payable in 1 year or more 20 Other liabilities (attach schedule) . . . . .21 Partners’ capital accounts . . . . . . .22 Total liabilities and capital . . . . . . .

Schedule M-1Reconciliation of Income (Loss) per Books With Income (Loss) per Return Note. Schedule M-3 may be required instead of Schedule M-1 (see instructions).

1 Net income (loss) per books . . . .

2 Income included on Schedule K, lines 1c through 4b, and 8, not recorded on books this year (itemize):

3 Guaranteed payments . . . . .

4 Expenses recorded on books this year not included on Schedule K, lines 1c through 4b, and 14g (itemize):

a Depreciation $b Travel and entertainment $


6 Income recorded on books this year not included on Schedule K, lines 1c through 4b, and 8 (itemize):


7 Deductions included on Schedule K, lines 1cthrough 4b, and 14g, not charged against book income this year (itemize):

a Depreciation $

8 Add lines 6 and 7 . . . . . . . .9 Income (loss). (Analysis of Net Income

(Loss), line 1.) Subtract line 8 from line 5 Schedule M-2 Analysis of Partners’ Capital Accounts

1 Balance at beginning of year . . .2 Capital contributed: a Cash . . .

b Property . .3 Net income (loss) per books . . . .4 Other increases (itemize):


6 Distributions: a Cash . . . . .b Property . . . .


8 Add lines 6 and 7 . . . . . . . .9 Balance at end of year. Subtract line 8 from

line 5 . . . . . . . . . . . .Form 1065-B (2010)

NEW

NEW


SCHEDULE M-3 (Form 1065)


Net Income (Loss) Reconciliation for Certain Partnerships

Attach to Form 1065 or Form 1065-B. See separate instructions.

OMB No. 1545-0099


This Schedule M-3 is being filed because (check all that apply): A The amount of the partnership’s total assets at the end of the tax year is equal to $10 million or more. B The amount of the partnership’s adjusted total assets for the year is equal to $10 million or more. If box B is checked,

enter the amount of adjusted total assets for the tax year . C The amount of total receipts for the tax year is equal to $35 million or more. If box C is checked, enter the total receipts for

the tax year . D An entity that is a reportable entity partner with respect to the partnership owns or is deemed to own an interest of 50

percent or more in the partnership’s capital, profit, or loss, on any day during the tax year of the partnership. Name of Reportable Entity Partner Identifying Number Maximum Percentage Owned or

Deemed Owned

E Voluntary Filer Part I Financial Information and Net Income (Loss) Reconciliation 1a Did the partnership file SEC Form 10-K for its income statement period ending with or within this tax year?

Yes. Skip lines 1b and 1c and complete lines 2 through 11 with respect to that SEC Form 10-K. No. Go to line 1b. See instructions if multiple non-tax-basis income statements are prepared.

b Did the partnership prepare a certified audited non-tax-basis income statement for that period? Yes. Skip line 1c and complete lines 2 through 11 with respect to that income statement. No. Go to line 1c.

c Did the partnership prepare a non-tax-basis income statement for that period? Yes. Complete lines 2 through 11 with respect to that income statement. No. Skip lines 2 through 3b and enter the partnership’s net income (loss) per its books and records on line 4a.

2 Enter the income statement period: Beginning / / Ending / / 3a Has the partnership’s income statement been restated for the income statement period on line 2?

Yes. (If “Yes,” attach an explanation and the amount of each item restated.) No.

b Has the partnership’s income statement been restated for any of the five income statement periods preceding the period on line 2? Yes. (If “Yes,” attach an explanation and the amount of each item restated.) No.

4 a Worldwide consolidated net income (loss) from income statement source identified in Part I, line 1 4a b Indicate accounting standard used for line 4a (see instructions):

1 GAAP 2 IFRS 3 704(b) 4 Tax-basis 5 Other: (Specify)

5 a Net income from nonincludible foreign entities (attach schedule) . . . . . . . . . . . . . 5a ( )

b Net loss from nonincludible foreign entities (attach schedule and enter as a positive amount) . . . 5b 6 a Net income from nonincludible U.S. entities (attach schedule) . . . . . . . . . . . . . 6a ( )

b Net loss from nonincludible U.S. entities (attach schedule and enter as a positive amount) . . . . 6b 7 a Net income (loss) of other foreign disregarded entities (attach schedule) . . . . . . . . . . 7a

b Net income (loss) of other U.S. disregarded entities (attach schedule) . . . . . . . . . . . 7b 8 Adjustment to eliminations of transactions between includible entities and nonincludible entities

(attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 9 Adjustment to reconcile income statement period to tax year (attach schedule) . . . . . . . . 9

10 Other adjustments to reconcile to amount on line 11 (attach schedule) . . . . . . . . . . . 10 11 Net income (loss) per income statement of the partnership. Combine lines 4 through 10 . . . 11

Note. Part I, line 11, must equal the amount on Part II, line 26, column (a). 12 Enter the total amount (not just the partnership’s share) of the assets and liabilities of all entities included or removed on the following lines:

Total Assets Total Liabilities a Included on Part I, line 4 b Removed on Part I, line 5 c Removed on Part I, line 6 d Included on Part I, line 7



Schedule M-3 (Form 1065) 2010 Page 2 Name of partnership Employer identification number

Part II Reconciliation of Net Income (Loss) per Income Statement of Partnership with Income (Loss) per Return

( ) ( )

Income (Loss) Items (a) Income (Loss) per Income Statement




Tax Return

(Attach schedules for lines 1 through 9) 1 Income (loss) from equity method foreign corporations 2 Gross foreign dividends not previously taxed . . .3 Subpart F, QEF, and similar income inclusions . .4 Gross foreign distributions previously taxed . . .5 Income (loss) from equity method U.S. corporations 6 U.S. dividends . . . . . . . . . . . . .7 Income (loss) from U.S. partnerships . . . . . .8 Income (loss) from foreign partnerships . . . . .9 Income (loss) from other pass-through entities . .

10 Items relating to reportable transactions (attach details) 11 Interest income (attach Form 8916-A) . . . . .12 Total accrual to cash adjustment . . . . . . .13 Hedging transactions . . . . . . . . . . .14 Mark-to-market income (loss) . . . . . . . .15 Cost of goods sold (attach Form 8916-A) . . . .16 Sale versus lease (for sellers and/or lessors) . . .17 Section 481(a) adjustments . . . . . . . . .18 Unearned/deferred revenue . . . . . . . . .19 Income recognition from long-term contracts . . .20 Original issue discount and other imputed interest .

21a Income statement gain/loss on sale, exchange, abandonment, worthlessness, or other disposition of assets other than inventory and pass-through entities .


c Gross capital losses from Schedule D, excluding amounts from pass-through entities, abandonment losses, and worthless stock losses . . . . . .

d Net gain/loss reported on Form 4797, line 17, excluding amounts from pass-through entities, abandonment losses, and worthless stock losses .

e Abandonment losses . . . . . . . . . . .f Worthless stock losses (attach details) . . . . .g Other gain/loss on disposition of assets other than inventory

22 Other income (loss) items with differences (attach schedule)

23 Total income (loss) items. Combine lines 1 through 22 . . . . . . . . . . . . . . . . .

24 Total expense/deduction items. (from Part III, line 31) (see instructions) . . . . . . . . . . .

25 Other items with no differences . . . . . . .26 Reconciliation totals. Combine lines 23 through 25

Note. Line 26, column (a), must equal the amount on Part I, line 11, and column (d) must equal Form 1065, page 5, Analysis ofNet Income (Loss), line 1.



Schedule M-3 (Form 1065) 2010 Page 3 Name of partnership Employer identification number

Part III Reconciliation of Net Income (Loss) per Income Statement of Partnership With Income (Loss) per Return—Expense/Deduction Items

Expense/Deduction Items (a)




(d) Deduction per

Tax Return

1 State and local current income tax expense . . .2 State and local deferred income tax expense . . .3 Foreign current income tax expense (other than

foreign withholding taxes) . . . . . . . . .4 Foreign deferred income tax expense . . . . .5 Equity-based compensation . . . . . . . .6 Meals and entertainment . . . . . . . . . .7 Fines and penalties . . . . . . . . . . .8 Judgments, damages, awards, and similar costs . .9 Guaranteed payments . . . . . . . . . .

10 Pension and profit-sharing . . . . . . . . .11 Other post-retirement benefits . . . . . . . .12 Deferred compensation . . . . . . . . . .13 Charitable contribution of cash and tangible

property . . . . . . . . . . . . . . .

14 Charitable contribution of intangible property . . .15 Organizational expenses as per Regulations

section 1.709-2(a) . . . . . . . . . . . .16 Syndication expenses as per Regulations

section 1.709-2(b) . . . . . . . . . . . .17 Current year acquisition/reorganization investment

banking fees . . . . . . . . . . . . . .18 Current year acquisition/reorganization legal and

accounting fees . . . . . . . . . . . . .19 Amortization/impairment of goodwill . . . . . .20 Amortization of acquisition, reorganization, and

start-up costs . . . . . . . . . . . . .21 Other amortization or impairment write-offs . . .22 Section 198 environmental remediation costs . . .23a Depletion—Oil & Gas . . . . . . . . . . .

b Depletion—Other than Oil & Gas . . . . . . .24 Intangible drilling & development costs . . . . .25 Depreciation . . . . . . . . . . . . . .26 Bad debt expense . . . . . . . . . . . .27 Interest expense (attach Form 8916-A) . . . . .28 Purchase versus lease (for purchasers and/

or lessees) . . . . . . . . . . . . .29 Research and development costs (attach schedule) .30 Other expense/deduction items with differences

(attach schedule) . . . . . . . . . . . .31 Total expense/deduction items. Combine lines 1

through 30. Enter here and on Part II, line 24, reporting positive amounts as negative and negative amounts as positive . . . . . . . . . . .


NEW NEW NEW NEW


SCHEDULE C (Form 1065)


Additional Information for Schedule M-3 Filers


OMB No. 1545-0099


Yes No1 At any time during the tax year, were there any transfers between the partnership and its partners subject to the

disclosure requirements of Regulations section 1.707-8? . . . . . . . . . . . . . . . . . . .

2 Do the amounts reported on Schedule M-3, Part II, lines 7 or 8, column (d), reflect allocations to this partnership from another partnership of income, gain, loss, deduction, or credit that are disproportionate to this partnership’s share of capital in such partnership or its ratio for sharing other items of such partnership? . . . . . . . .

3 At any time during the tax year, did the partnership sell, exchange, or transfer any interest in an intangible asset to a related person as defined in sections 267(b) and 707(b)(1)? . . . . . . . . . . . . . . . . . .

4 At any time during the tax year, did the partnership acquire any interest in an intangible asset from a relatedperson as defined in sections 267(b) and 707(b)(1)? . . . . . . . . . . . . . . . . . . . . .

5 At any time during the tax year, did the partnership make any change in accounting principle for financialaccounting purposes? See instructions for a definition of change in accounting principle . . . . . . . .

6 At any time during the tax year, did the partnership make any change in a method of accounting for U.S. incometax purposes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

For Paperwork Reduction Act Notice, see the Instructions for Form 1065. Cat. No. 49945S Schedule C (Form 1065) 2010




Profit or Loss From Farming

Attach to Form 1040, Form 1040NR, Form 1041, Form 1065, or Form 1065-B. See Instructions for Schedule F (Form 1040).

OMB No. 1545-0074



A Principal product. Describe in one or two words your principal crop or activity for the current tax year. B Enter code from Part IV

C Accounting method: (1) Cash (2) Accrual

D Employer ID number (EIN), if any

E Did you “materially participate” in the operation of this business during 2010? If “No,” see page F-2 for limit on passive losses. Yes No

Part I Farm Income—Cash Method. Complete Parts I and II (Accrual method. Complete Parts II and III, and Part I, line 11.) Do not include sales of livestock held for draft, breeding, sport, or dairy purposes. Report these sales on Form 4797.

1 Sales of livestock and other items you bought for resale . . . . . . 1

2 Cost or other basis of livestock and other items reported on line 1 . . . 2


4 Sales of livestock, produce, grains, and other products you raised . . . . . . . . . . . . 4


6a Agricultural program payments (see page F-3) . 6a 6b Taxable amount 6b

7 Commodity Credit Corporation (CCC) loans (see page F-3):



8 Crop insurance proceeds and federal crop disaster payments (see page F-3):

a Amount received in 2010 . . . . . . . 8a 8b Taxable amount 8b

c If election to defer to 2011 is attached, check here 8d Amount deferred from 2009 8d


10 Other income, including federal and state gasoline or fuel tax credit or refund (see page F-3) . . . . . . 10

11 Gross income. Add amounts in the right column for lines 3 through 10. If you use the accrual method to figure your income, enter the amount from Part III, line 51 . . . . . . . . . . . . . . 11

Part II Farm Expenses—Cash and Accrual Method. Do not include personal or living expenses such as taxes, insurance, or repairs on your home.

12 Car and truck expenses (see page

F-5). Also attach Form 4562 . 12

13 Chemicals . . . . . . 13

14 Conservation expenses (see page F-5) . . . . . . 14

15 Custom hire (machine work) . 15

16 Depreciation and section 179 expense deduction not claimed elsewhere (see page F-5) . 16

17 Employee benefit programs other

than on line 25 . . . . . 17

18 Feed . . . . . . . 18

19 Fertilizers and lime . . . 19

20 Freight and trucking . . . 20

21 Gasoline, fuel, and oil . . . 21


23 Interest:


b Other . . . . . . . 23b24 Labor hired (less employment credits) 24

25 Pension and profit-sharing plans . . . . . . . . 25

26 Rent or lease (see page F-6):

Vehicles, machinery, and equipment . . . . . . .

a26a

b Other (land, animals, etc.) . . 26b

27 Repairs and maintenance . . 27

28 Seeds and plants . . . . . 28

29 Storage and warehousing . . 29

30 Supplies . . . . . . . 30

31 Taxes . . . . . . . . 31

32 Utilities . . . . . . . . 32

33 Veterinary, breeding, and medicine 33

34 Other expenses (specify):

a 34a

b 34b

c 34c

d 34d

e 34ef 34f

35 Total expenses. Add lines 12 through 34f. If line 34f is negative, see instructions . . . . . . . 35

36 Net farm profit or (loss). Subtract line 35 from line 11. Partnerships, see page F-7.

}• If a profit, enter the profit on both Form 1040, line 18, and Schedule SE, line 1a; on Form 1040NR, line 19; or on Form 1041, line 6. 36

• If a loss, you must go to line 37.

37 If you have a loss, you must check the box that describes your investment in this activity (see page F-7). }• If you checked 37a, enter the loss on both Form 1040, line 18, and Schedule SE, line 1a; on Form 1040NR, line 19; or on Form 1041, line 6.

37a All investment is at risk.


• If you checked 37b, you must attach Form 6198. Your loss may be limited.




Investment Credit

Attach to your tax return. See instructions.

OMB No. 1545-0155




1 Name of lessor2 Address of lessor3 Description of property4 Amount for which you were treated as having acquired the property . . . . . . . . . . $













a Check this box if you are electing under section 47(d)(5) to take your qualified rehabilitation expenditures into account for the tax year in which paid (or, for self-rehabilitated property, when capitalized). See instructions. Note. This election applies to the current tax year and to all later tax years. You may not revoke this election without IRS consent . . . . . . . . . . .





Cat. No. 12276E Form 3468 (2010)

NEW











. . . . . . . . . . . . . . . . . . . . . $ × 10% (.10) 12a


. . . . . . . . . . . . . . . . . . . . . $ × 30% (.30) 12b



. . . . . . . . . . . . . . . . . . . . . $ × 30% (.30) 12c

d Applicable kilowatt capacity of property on line 12c (see instructions) × $1,000 12d



g Applicable kilowatt capacity of property on line 12f (see instructions) × $3,000 12g



j Kilowatt capacity of property on line 12i . . . . . . . . . . × $200 12j










. . . . . . . . . . . . . . . . . . . . . $ × 30% (.30) 12o













20 Add lines 16 through 19. Report this amount on Form 3800, line 29a . . . . . . . . . . 20Form 3468 (2010)



General Business Credit See separate instructions. Attach to your tax return.

OMB No. 1545-0895








claiming this credit from a pass-through entity: ) . . . . . 1k l Biodiesel and renewable diesel fuels credit . . . . . . . . . . . . . . . . . 1l m Low sulfur diesel fuel production credit (Form 8896) . . . . . . . . . . . . . . 1m n Distilled spirits credit (Form 8906) . . . . . . . . . . . . . . . . . . . . 1n o Nonconventional source fuel credit (Form 8907) . . . . . . . . . . . . . . . 1o p Energy efficient home credit . . . . . . . . . . . . . . . . . . . . . . 1p q Energy efficient appliance credit (Form 8909) . . . . . . . . . . . . . . . . 1q r Alternative motor vehicle credit (Form 8910) (enter EIN if claiming this credit from a













See separate instructions. Attach to your tax return.

OMB No. 1545-0172







10 Carryover of disallowed deduction from line 13 of your 2009 Form 4562 . . . . . . . . . . . 1011 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions) 1112 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 . . . . . 1213 Carryover of disallowed deduction to 2011. Add lines 9 and 10, less line 12 13

Note: Do not use Part II or Part III below for listed property. Instead, use Part V.Part II Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions.)14 Special depreciation allowance for qualified property (other than listed property) placed in service



asset accounts, check here . . . . . . . . . . . . . . . . . . . . Section B—Assets Placed in Service During 2010 Tax Year Using the General Depreciation System

(a) Classification of property

(b) Month and year placed in

service



(d) Recovery period


19a 3-year propertyb 5-year propertyc 7-year propertyd 10-year propertye 15-year propertyf 20-year propertyg 25-year propertyh Residential rental







=50 YEAR PROP






vehicles first)

(b) Date placed

in service

(c) Business/




use only)

(f) Recovery

period

(g) Method/

Convention

(h) Depreciation

deduction


cost







(a) Vehicle 1

(b) Vehicle 2

(c) Vehicle 3

(d) Vehicle 4

(e) Vehicle 5

(f) Vehicle 6


driven . . . . . . . . . . . .














begins


(d) Code section

(e) Amortization





Form 4562 (2010)Page 22

42(d): E480, E481, E482,E483, E484, E485, E486,E487, E488, E395, E397,E398, E399

178 The cost of acquiring a lease; 195 Business start-up expenditures; 174 Research and experimental expenditures; 197 Various intangibles;169 Pollution control facilities; 167(h) Certain Geophysical Expenditures; 171 Taxable Bonds Premiums (after 8/8/05); 248 Corporate OrganizationalExpenditures; 1400l Qualified Revitalization Expenditures

709 Organizational Expenditures for Partnerships; 59(e) Optional write-off of certain taxpreferences; 194 Qualified forestation and reforestation costs; (more below)




Under Sections 179 and 280F(b)(2)) Attach to your tax return. See separate instructions.

OMB No. 1545-0184














sum of (d) and (e)




















* *These items will show as one entry on the editing screen.

gain**loss**

loss**gain**

SOCA Code

SOCA Code





OMB No. 1545-0219


















Cat. No. 13570D Form 5884 (2010)




New Hire Retention Credit Attach to your tax return.

Use Part II to list additional retained workers.

OMB No. 1545-2202








(c)





4 Multiply line 3 by 80% (.80) . . . . . . . . . 45

Enter the retained worker's wages for the second 26 consecutive weeks of employment. If line 4 is larger than this amount, the qualified employee is not a retained worker and should not be listed on this form 5

6 Add lines 3 and 5 . . . . . . . . . . . . 6

7 Multiply line 6 by 6.2% (.062) . . . . . . . . 7

8 Maximum credit allowable . . . . . . . . . 8





13

Current year credit. Add lines 10 and 12. Partnerships and S corporations, report this amount onSchedule K; all others, report this amount on the applicable line of Form 3800 (e.g., line 1aa of the2010 Form 3800) . . . . . . . . . . . . . . . . . . . . . . . . . . . 13




Credit for Increasing Research Activities


OMB No. 1545-0619



Section A—Regular Credit. Skip this section and go to Section B if you are electing or previously elected (and are not revoking) the alternative simplified credit.

1 Certain amounts paid or incurred to energy consortia (see instructions) . . . . . . . . . 1 2 Basic research payments to qualified organizations (see instructions) . 2 3 Qualified organization base period amount . . . . . . . . . . 3 4 Subtract line 3 from line 2. If zero or less, enter -0- . . . . . . . . . . . . . . . . 4 5 Wages for qualified services (do not include wages used in figuring the

work opportunity credit) . . . . . . . . . . . . . . . . 5 6 Cost of supplies . . . . . . . . . . . . . . . . . . 6 7 Rental or lease costs of computers (see instructions) . . . . . . 7 8 Enter the applicable percentage of contract research expenses (see

instructions) . . . . . . . . . . . . . . . . . . . . 8 9 Total qualified research expenses. Add lines 5 through 8 . . . . . 9

10 Enter fixed-base percentage, but not more than 16% (see instructions) . 10 % 11 Enter average annual gross receipts (see instructions) . . . . . . 11 12 Multiply line 11 by the percentage on line 10 . . . . . . . . . 12 13 Subtract line 12 from line 9. If zero or less, enter -0- . . . . . . . 13 14 Multiply line 9 by 50% (.50) . . . . . . . . . . . . . . . 14 15 Enter the smaller of line 13 or line 14 . . . . . . . . . . . . . . . . . . . . 15 16 Add lines 1, 4, and 15 . . . . . . . . . . . . . . . . . . . . . . . . . . 16 17 Are you electing the reduced credit under section 280C? Yes No

If “Yes,” multiply line 16 by 13% (.13). If “No,” multiply line 16 by 20% (.20) and see theinstructions for the schedule that must be attached. Members of controlled groups or businessesunder common control: see instructions for the schedule that must be attached . . . . . . 17

Section B—Alternative Simplified Credit. Skip this section if you are completing Section A.

18 Certain amounts paid or incurred to energy consortia (see the line 1 instructions) . . . . . . 18 19 Basic research payments to qualified organizations (see the line 2

instructions) . . . . . . . . . . . . . . . . . . . . 19 20 Qualified organization base period amount (see the line 3 instructions) . 2021 Subtract line 20 from line 19. If zero or less, enter -0- . . . . . . . . . . . . . . . 2122 Add lines 18 and 21 . . . . . . . . . . . . . . . . . . . . . . . . . . 22 23 Multiply line 22 by 20% (.20) . . . . . . . . . . . . . . . . . . . . . . . 2324 Wages for qualified services (do not include wages used in figuring the

work opportunity credit) . . . . . . . . . . . . . . . . 24 25 Cost of supplies . . . . . . . . . . . . . . . . . . 2526 Rental or lease costs of computers (see the line 7 instructions) . . . 26 27 Enter the applicable percentage of contract research expenses (see the

line 8 instructions) . . . . . . . . . . . . . . . . . . 27 28 Total qualified research expenses. Add lines 24 through 27 . . . . 2829 Enter your total qualified research expenses for the prior 3 tax years. If

you had no qualified research expenses in any one of those years, skip lines 30 and 31 . . . . . . . . . . . . . . . . . . . 29

30 Divide line 29 by 6.0 . . . . . . . . . . . . . . . . . 3031 Subtract line 30 from line 28. If zero or less, enter -0- . . . . . . 3132 Multiply line 31 by 14% (.14). If you skipped lines 30 and 31, multiply line 28 by 6% (.06) . . . . 32

For Paperwork Reduction Act Notice, see instructions. Cat. No. 13700H Form 6765 (2010)


Form 6765 (2010) Page 2

Section B—Alternative Simplified Credit (continued).

33 Add lines 23 and 32 . . . . . . . . . . . . . . . . . . . . . . . . . . 3334 Are you electing the reduced credit under section 280C? Yes No

34

If “Yes,” multiply line 33 by 65% (.65). If “No,” enter the amount from line 33 and see the line 17 instructions for the schedule that must be attached. Members of controlled groups or businesses under common control: see instructions for the schedule that must be attached . . . . . .

Section C—Summary

35 Enter the portion of the credit from Form 8932, line 2, that is attributable to wages that were also used to figure the credit on line 17 or line 34 (whichever applies) . . . . . . . . . . . . 35

36 Subtract line 35 from line 17 or line 34 (whichever applies). If zero or less, enter -0- . . . . . 3637 Credit for increasing research activities from partnerships, S corporations, estates, and trusts . . 37 38 Add lines 36 and 37. Estates and trusts go to line 39; partnerships and S corporations, report this

amount on Schedule K; all others, report this amount on line 1c of Form 3800 . . . . . . . 3839 Amount allocated to beneficiaries of the estate or trust (see instructions) . . . . . . . . . 3940 Estates and trusts: subtract line 39 from line 38. Report the credit on line 1c of Form 3800 . . . 40

Form 6765 (2010)

Section 3081 Refundable Research Credit


OMB No. 1545-1505 Orphan Drug Credit 8820 Form



1 1

2a 2a

3

4

3

4

Form 8820 (Rev. 12-2008) Cat. No. 11208S

Qualified clinical testing expenses paid or incurred during the tax year

Current year credit. Multiply line 1 by 50% (.50) (see instructions)

Orphan drug credit from partnerships, S corporations, estates, or trusts

Add lines 2c and 3. Estates and trusts go to line 5. Partnerships and S corporations, report this amount on Schedule K. All others, report this amount on the applicable line of Form 3800 (e.g., line 1h of the 2008 Form 3800)


5 Amount allocated to the beneficiaries of the estate or trust (see instructions)

6 Estates and trusts. Subtract line 5 from line 4. Report this amount on the applicable line of Form 3800 (e.g., line 1h of the 2008 Form 3800)

5

6

2b b Enter the portion of the credit from Form 8932, line 2, that is attributable to wages that were also

used to figure the credit on line 2a above

2c c Subtract line 2b from 2a. If zero or less, enter -0-





OMB No. 1545-1190


2010










7 Was the exchange of the property given up or received made with a related party, either directly or indirectly (such as through an intermediary)? See instructions. If “Yes,” complete Part II. If “No,” go to Part III . . . Yes No











SOCA Code











26 Enter the number from the upper right corner of your certificate of divestiture. (Do not attach a copy of your certificate. Keep the certificate with your records.) . . . . . . . . . . � –

27 Description of divested property �

28 Description of replacement property �


30 Sales price of divested property (see instructions) . . . . . . 30



of sale . . . . . . . . . . . . . . . . . . . . 33






Multi-asset exchanges


Form 8825 (Rev. December 2010) Department of the Treasury Internal Revenue Service

Rental Real Estate Income and Expenses of a Partnership or an S Corporation

See instructions on back. Attach to Form 1065, Form 1065-B, or Form 1120S.

OMB No. 1545-1186

Name Employer identification number

1 Show the type and address of each property. For each rental real estate property listed, report the number of days rented at fair rental value and days with personal use. See instructions. See page 2 to list additional properties. Physical address of each property—street, city, state, ZIP code

Type—Enter code 1-8; see page 2 for list

Fair Rental Days Personal Use Days

A

B

C

D

Properties Rental Real Estate Income A B C D

2 Gross rents . . . . . . . 2

Rental Real Estate Expenses 3 Advertising . . . . . . . 3 4 Auto and travel . . . . . 4 5 Cleaning and maintenance . . 5 6 Commissions . . . . . . 6 7 Insurance . . . . . . . 7 8 Legal and other professional fees 8 9 Interest . . . . . . . . 9

10 Repairs . . . . . . . . 10 11 Taxes . . . . . . . . 11 12 Utilities . . . . . . . . 12 13 Wages and salaries . . . . 13 14 Depreciation (see instructions) 14 15 Other (list)

15

16 Total expenses for each property.Add lines 3 through 15 . . . 16

17 Income or (Loss) from each property. Subtract line 16 from line 2 17

18a Total gross rents. Add gross rents from line 2, columns A through H . . . . . . . . . 18a b Total expenses. Add total expenses from line 16, columns A through H . . . . . . . . 18b ( )

19 Net gain (loss) from Form 4797, Part II, line 17, from the disposition of property from rental real estate activities . . . . . . . . . . . . . . . . . . . . . . . . . . 19

20a Net income (loss) from rental real estate activities from partnerships, estates, and trusts in which this partnership or S corporation is a partner or beneficiary (from Schedule K-1) . . . . . 20a

b Identify below the partnerships, estates, or trusts from which net income (loss) is shown on line 20a. Attach a schedule if more space is needed:

(1) Name (2) Employer identification number

21 Net rental estate income (loss). Combine lines 18a through 20a. Enter the result here and on: • Form 1065 or 1120S: Schedule K, line 2, or • Form 1065-B: Part I, line 4

21

For Paperwork Reduction Act Notice, see back of form. Cat. No. 10136Z Form 8825 (12-2010)

Count of the Total Number of Properties

Lines 2 through 16 are a total for all properties.





OMB No. 1545-1374





(a) Vehicle 1

(b) Vehicle 2

(c) Vehicle 3







(a) Vehicle 1

(b) Vehicle 2

(c) Vehicle 3

14


15 Multiply line 14 by 10% (.10) . . . . . . . . . . 1516



credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21



00 2,500 00 2,500 00 2,500





OMB No. 1545-1444



1 Enter the total qualified wages paid or incurred during the calendar year only (see instructions)a Qualified empowerment zone wages . . . . . . $ × 20% (.20) 1ab Qualified renewal community wages . . . . . . $ × 15% (.15) 1b

2 Add lines 1a and 1b. See instructions for the adjustment you must make to salaries and wages . . . 2







9 Carryback of empowerment zone and renewal community employment credit from 2011 (see instructions) 9







Indian Employment Credit


OMB No. 1545-1417



1 Total of qualified wages and qualified employee health insurance costs paid or incurred during thetax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Calendar year 1993 qualified wages and qualified employee health insurance costs (see instructions). If none, enter -0- . . . . . . . . . . . . . . . . . . . . . 2

3 Incremental increase. Subtract line 2 from line 1. If zero or less, enter -0- . . . . . . . . . 3 4 Multiply line 3 by 20% (.20) (see instructions for the adjustment you must make for salaries

and wages) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Indian employment credits from partnerships, S corporations, cooperatives, estates,

and trusts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Add lines 4 and 5. Cooperatives, estates, and trusts, go to line 7; partnerships and S corporations,

report this amount on Schedule K; all others, report this amount on Form 3800, line 1g . . . . 67 Amount allocated to patrons of the cooperative or beneficiaries of the estate or trust (see

instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Cooperatives, estates, and trusts. Subtract line 7 from line 6. Report this amount on

Form 3800, line 1g . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

For Paperwork Reduction Act Notice, see back of form. Cat. No. 16146D Form 8845 (2010)





OMB No. 1545-1414

2010Attachment





4 Multiply line 3 by 7.65% (.0765). If you had any tipped employees whose wages (including tips) exceeded $106,800 or were exempt from social security taxes, see instructions and check here . . . . . . . . . . . . . . . . . . . . . . . . . . 4








Cat. No. 16148Z

Form 8846 (2010)





OMB No. 1545-1924





Type of Fuel(a)


(b) Rate

(c)

Column (a) x Column (b)

1 Biodiesel (other than agri-biodiesel) . . . . . . . . . 1 2 Agri-biodiesel . . . . . . . . . . . . . . . . 23 Renewable diesel . . . . . . . . . . . . . . . 3 4 Biodiesel (other than agri-biodiesel) included in a biodiesel

mixture . . . . . . . . . . . . . . . . . . 4

5 Agri-biodiesel included in a biodiesel mixture . . . . . . 5

6 Renewable diesel included in a renewable diesel mixture . . 6

7 Qualified agri-biodiesel production . . . . . . . . . 7 8 Add lines 1 through 7. Include this amount in your income for 2010 (see instructions) . . . . . 89 Biodiesel and renewable diesel fuels credit from partnerships, S corporations, cooperatives,







Form

8874



Cat. No. 31663N

Form 8874 (Rev. 12-2006)


Identifying number

(e)

Creditrate




number of CDE



1


3

%

%

%

3

2


2



OMB No. 1545-1804

New Markets Credit


%

%

%

(Total)


OMB No. 1545-1810

Credit for Small Employer Pension PlanStartup Costs

Form 8881 � Attach to your tax return.



Identifying number Name(s) shown on return

1

2 2 3

4

5

Form 8881 (Rev. 12-2006)

Qualified startup costs incurred during the tax year. Do not enter more than $1,000

3 Credit for small employer pension plan startup costs from partnerships and S corporations

5 Enter the smaller of line 4 or $500. Partnerships and S corporations, report this amount onSchedule K; all others report this amount on the applicable line of Form 3800, (e.g., line 1m ofthe 2006 Form 3800)

Cat. No. 33435N

Enter one-half of line 1

4

1

Add lines 2 and 3


OMB No. 1545-1809 Credit for Employer-Provided ChildcareFacilities and Services

8882

Form

Department of the TreasuryInternal Revenue Service Identifying number


Form 8882 (Rev. 12-2006)

Cat. No. 33436Y


AttachmentSequence No.131


1

2 2

3

5

Qualified childcare facility expenditures paid or incurred (seeinstructions)

3

5

Enter the smaller of line 6 or $150,000. Estates and trusts, go to line 8. All others report thisamount as follows: partnerships and S corporations, report this amount on Schedule K; allothers, report the credit on the applicable line of Form 3800, (e.g., line 1n of the 2006 Form3800)


4

1

Add lines 2, 4, and 5

Qualified childcare resource and referral expenditures paid or incurred


6

7

6

7

4

Credit for employer-provided childcare facilities and services from partnerships, S corporations, estates, and trusts (see instructions)


Amount allocated to beneficiaries of the estate or trust (see instructions) 8

Estates and trusts. Subtract line 8 from line 7. Report the credit on the applicable line of Form3800 (e.g., line 1n of the 2006 Form 3800)

9

8

9


OMB No. 1545-1914 Low Sulfur Diesel Fuel Production Credit 8896 Form



1 1 Low sulfur diesel fuel produced (in gallons) 2 Multiply line 1 by $.05

2

5 6

Qualified capital costs limitation (see instructions)

3

6

Form 8896 (Rev. 12-2006)

Enter the smaller of line 5 or line 2

Total low sulfur diesel fuel production credits allowed for all prior tax years


5

8 Add lines 6 and 7. Cooperatives go to line 9; partnerships and S corporations, report this amount on Schedule K; all others, report this amount on the applicable line of Form 3800 (e.g., line 1qof the 2006 Form 3800)

8

3 4

7

7

Low sulfur diesel fuel production credit from partnerships, S corporations, and cooperatives


9 Amount allocated to the patrons of the cooperative

9 10 Subtract line 9 from line 8. Report this amount on the applicable line of Form 3800 (e.g., line 1q

of the 2006 Form 3800) 10



Domestic Production Activities Deduction

Attach to your tax return. See separate instructions.

OMB No. 1545-1984




(b) All activities

1 Domestic production gross receipts (DPGR) . . . . . . . . 1 2 Allocable cost of goods sold. If you are using the small business

simplified overall method, skip lines 2 and 3 . . . . . . . . 2 3 Enter deductions and losses allocable to DPGR (see instructions) . 3 4

If you are using the small business simplified overall method, enter the amount of cost of goods sold and other deductions or losses you ratably apportion to DPGR. All others, skip line 4 . . . . . . . 4




instructions) . . . . . . . . . . . . . . . . . . 9 10

a

Oil-related qualified production activities income. Estates andtrusts, subtract line 9, column (a), from line 8, column (a), all others, enter amount from line 8, column (a). If zero or less, enter -0- here . 10a

b

Qualified production activities income. Estates and trusts, subtract line 9, column (b), from line 8, column (b), all others, enter amount from line 8, column (b). If zero or less, enter -0- here, skip lines 11through 21, and enter -0- on line 22 . . . . . . . . . . . 10b

11 Income limitation (see instructions):• Individuals, estates, and trusts. Enter your adjusted gross income figured without the domestic production activities deduction . . . . . . . . . . . . . . . . } 11 • All others. Enter your taxable income figured without the domestic production activities deduction (tax-exempt organizations, see instructions) . . . . . . . . . . .


13 Enter 9% of line 12 . . . . . . . . . . . . . . . . . . . . . . . . . 13 14 a Enter the smaller of line 10a or line 12 . . . . . . . . . . 14a

b Reduction for oil-related qualified production activities income. Multiply line 14a by 3% . . 14b15 Subtract line 14b from line 13 . . . . . . . . . . . . . . . . . . . . . . 1516 Form W-2 wages (see instructions) . . . . . . . . . . . . . . . . . . . . 1617 Form W-2 wages from estates, trusts, and certain partnerships and S corporations

(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 1718 Add lines 16 and 17. Estates and trusts, go to line 19, all others, skip line 19 and go to line 20 1819 Amount allocated to beneficiaries of the estate or trust (see instructions) . . . . . . . 1920 Estates and trusts, subtract line 19 from line 18, all others, enter amount from line 18 . . . 2021 Form W-2 wage limitation. Enter 50% of line 20 . . . . . . . . . . . . . . . . 2122 Enter the smaller of line 15 or line 21. . . . . . . . . . . . . . . . . . . . 2223 Domestic production activities deduction from cooperatives. Enter deduction from Form



For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 37712F Form 8903 (Rev. 12-2010)

NEW

NEW



Alternative Motor Vehicle Credit See separate instructions.


OMB No. 1545-1998



Note.• Use this form to claim the credit for certain alternative motor vehicles or plug-in electric vehicle conversions.• Claim the credit for certain two-or three-wheeled or low-speed four-wheeled plug-in electric vehicles on Form 8834.• Claim the credit for certain other plug-in electric vehicles on Form 8936.





3 Credit allowable (see instructions for amount to enter) 3

4

If you are not claiming the plug-in conversion credit, skip lines 4 through 8, enter -0- on line 9, and go to line 10. Otherwise, enter the cost of converting the vehicle to a qualified plug-in electric drive motor vehicle . . . . 4

5 Section 179 expense deduction (see instructions) . . 56 Subtract line 5 from line 4 . . . . . . . . . . 67 Multiply line 6 by 10% (.10) . . . . . . . . . 78 Maximum plug-in conversion credit amount allowable . 8 4,000 00 4,000 00 4,000 00

9 Enter the smaller of line 7 or line 8 . . . . . . . 910 Tentative credit. Add lines 3 and 9 . . . . . . . 10

/ / /







16






Lines 4-10 will be the sum of all columns.





OMB No. 1545-1981

2010Attachment





1 Total cost of qualified alternative fuel vehicle refueling property placed in service during the tax year . . . . . . . . . . . . . . . 1


2 Business/investment use part (see instructions) . . . . . . . 2 3 Section 179 expense deduction (see instructions) . . . . . . 3 4 Subtract line 3 from line 2 . . . . . . . . . . . . . . 4 5 Applicable credit rate decimal amount . . . . . . . . . . 5 .30 .506 Multiply line 4 by the applicable decimal amount on line 5 . . . . 67 Maximum business/investment use part of credit (see instructions) . 78 Enter the smaller of line 6 or line 7. . . . . . . . . . . . 89 Add columns (a) and (b) on line 8 . . . . . . . . . . . . . . . . . . . . 9

10 Alternative fuel vehicle refueling property credit from partnerships and S corporations . . . 1011 Business/investment use part of credit. Add lines 9 and 10. Partnerships and S corporations,

report this amount on Schedule K; all others, report this amount on Form 3800, line 1s . . . . . 11


12 Subtract line 2 from line 1. If zero, stop here; do not file this form unless you are claiming a credit on line 11 . . . . . . . . . 12

13 Applicable credit rate decimal amount . . . . . . . . . . 13 .30 .5014 Multiply line 12 by the applicable decimal amount on line 13 . . . 1415 Maximum personal use part of credit (see instructions) . . . . . 1516 Enter the smaller of line 14 or line 15 . . . . . . . . . . 1617 Add columns (a) and (b) on line 16 . . . . . . . . . . . . . . . . . . . . 1718 Regular tax before credits:

• Individuals. Enter the amount from Form 1040, line 44 (or Form 1040NR, line 42) • Other filers. Enter the regular tax before credits from your return . . . . � . . . .



20 Net regular tax. Subtract line 19d from line 18. If zero or less, stop here; do not file this formunless you are claiming a credit on line 11 . . . . . . . . . . . . . . . . . 20


� . . . 21

22 Subtract line 21 from line 20. If zero or less, stop here; do not file this form unless you are claiming a credit on line 11 . . . . . . . . . . . . . . . . . . . . . . 22

23 Personal use part of credit. Enter the smaller of line 17 or line 22 here and on Form1040, line 53; Form 1040NR, line 50; or the appropriate line of your return. If line 22 is smaller than line 17, see instructions . . . . . . . . . . . . . . . . . . . . . 23



Form 8925 (December 2009) Department of the Treasury Internal Revenue Service (99)

Report of Employer-Owned Life Insurance Contracts � Attach to the policyholder’s tax return—See instructions.

OMB No. 1545-2089



Name of policyholder, if different from above Identifying number, if different from above

Type of business

1 Enter the number of employees the policyholder had at the end of the tax year . . . . . 1 2 Enter the number of employees included on line 1 who were insured at the end of the tax

year under the policyholder’s employer-owned life insurance contract(s) issued after August 17, 2006. See Section 1035 exchanges below for an exception . . . . . . . . . . 2

3 Enter the total amount of employer-owned life insurance in force at the end of the tax year for employees who were insured under the contract(s) specified on line 2 . . . . . . . 3

4 a Does the policyholder have a valid consent (see instructions) for each employee included on line 2? . . . . . . . . . . . . . . . Yes No

b If “No,” enter the number of employees included on line 2 for whom the policyholder does not have a valid consent . . . . . . . . . . . . . . . . . . . . . . . 4b

Form 8925 (12-2009)

Cat. No. 37737A


Form




OMB No. 1545-2137



Part I

Part III


Identifying number

Tentative Credit







2 3

5

2

3

5

(a) Vehicle 1

(b) Vehicle 2

(c) Vehicle 3

Form 8936 (2010)

Cat. No. 37751E

6


1

1


9


7

13

14



12

13

14

7


/ /

/ /

/ /


4

4

%

%

%

Part II


8 8

11


10

10

12

9




11

10








OMB No. 1545-2198







5



7 Multiply line 6 by the applicable percentage:• Tax-exempt small employers, multiply line 6 by 25% (.25)• All other small employers, multiply line 6 by 35% (.35) . . . . . . . . . . . . . 7

8 If line 2 is 10 or less, enter the amount from line 7. Otherwise, see instructions . . . . . . 89 If line 3 is $25,000 or less, enter the amount from line 8. Otherwise, see instructions . . . . 9
















548 Non-SOI Data Programs


Required Payment or Refund Under Section 7519 Do not attach this form to Form 1065, Form 1065-B, or Form 1120S; file it separately.

For the required payment computed using the net income from the base year ending , 2010

Due by May 16, 2011

OMB No. 1545-1181

2010

Typ

e o

r p

rint

Name of partnership or S corporation Employer identification number



A Check applicable box to show how entity is classified for federal income tax purposes: (1) Partnership(2) S Corporation

B If this is the entity’s first tax year, skip lines 1 through 10, enter -0- on line 11, and check this box . . . . . . . C If this form is being filed to claim a full refund of the net required payment balance because of a terminating event, skip

lines 1 through 9a, enter -0- on line 9b, complete lines 10-12, and check this box . . . . . . . . . . . . .

D If the entity had a short base year (a base year of less than 12 months), check this box. See the line 1 instructions for the definition of “base year” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 Net income for base year. If the entity had a short base year, increase the net income for theshort base year by the applicable payments made during the base year (line 2 below), and multiply the result by the ratio of 12 over the number of months in the short base year. Carry out the ratio to at least 3 decimal places. If zero or less, enter -0- . . . . . . . . . . . . 1

2 Applicable payments made during base year . . . . . . . . . . . . . . . . . 23 Deferral ratio. Divide the number of months in the deferral period by 12 and enter the result as a

percentage. Carry out your answer to at least the nearest tenth of a percent . . . . . . . 3 . %

4 Line 1 deferred amount. Multiply line 1 by line 3 . . . . . . . . . . . . . . . . 4Caution. If the entity had a short base year, skip lines 5 and 6 and go to line 7.

5 Line 2 deferred amount. Multiply line 2 by line 3 . . . . . . 56 Applicable payments made during the deferral period of the base

year . . . . . . . . . . . . . . . . . . . . 67 If the entity had a 12-month base year, subtract line 6 from line 5. If zero or less, enter -0-. If the

entity had a short base year, enter the applicable payments made during the deferral period ofthe applicable election year . . . . . . . . . . . . . . . . . . . . . . . 7

8 Net base year income. If the entity had a 12-month base year, add lines 4 and 7. If the entity had a short base year, subtract line 7 from line 4. If zero or less, enter -0- . . . . . . . . . 8

9a Multiply line 8 by 36% (.36) . . . . . . . . . . . . . 9ab If line 9a is more than $500 or the required payment for any prior tax year was more than $500,

enter the amount from line 9a here. Otherwise, enter -0- . . . . . . . . . . . . 9b10 Net required payment balance. Enter the excess of the required payments made for all prior

years over the refunds of any required payments received for all prior years . . . . . . . 1011 Required payment due. If line 9b is larger than line 10, subtract line 10 from line 9b. See the

line 11 instructions for payment options . . . . . . . . . . . . . . . . . . . 11

12 Refund of net prior year payments. If line 10 is larger than line 9b, subtract line 9b from line 10 12

Sign Here

Keep a copy of this form for your records.


▶ Signature of officer, general partner, or limited liability company member Date ▶ Title



PTIN



Form 8752 (2010)

proposed tax year 2010 forms and schedulesbasic individual study iv form 5329, additional taxes on...

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